Blue Shield of California's mission is to ensure all Californians have access to high-quality health care at a sustainably affordable price. We are transforming health care in a way that truly serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.
To fulfill our mission, we must ensure a diverse, equitable, and inclusive environment where all employees can be their authentic selves and fully contribute to meet the needs of the multifaceted communities we serve. Our comprehensive approach to diversity, equity, and inclusion combines a focus on our people, processes, and systems with a deep commitment to promoting social justice and health equity through our products, business practices, and presence as a corporate citizen.
Blue Shield has received awards and recognition for being a certified Great Place to Work, best place to work for LGBTQ equality, leading disability employer, one of the best companies for women to advance, Bay Area's top companies in volunteering & giving, and one of the world's most ethical companies. Here at Blue Shield of California, we are striving to make a positive change across our industry and the communities we live in - join us!
Your Role
The Risk Adjustment team within the Actuarial Department is hiring a Medicare Dashboard Legislation Consultant. The Medicare Dashboard Legislation Lead will report to the Senior Director of Medicare Revenue Management . In this role you will be involved in dashboard design and storytelling to communicate project updates to leadership. Other responsibilities involve monitoring changes to Medicare legislation and ensuring internal processes are in compliance with regulatory requirements as well as various activities to promote growth of the Medicare and other lines of business.
Your Work
In this role, you will:
Make recommendations based on understanding the core principles and functionality of decision, descriptive, predictive, and prescriptive analytic methods
Drive leadership, guidance, and manage all aspects of a given program, including vendor oversight, internal cross-functional partnerships, tracking performance and measuring results
Manage data analysis, documenting and verifying the assumptions used in computations such as those used in member risk data and score submissions and establishing revenue accruals
Manage the development and implementation of process of company's projects involving departmental or cross-functional teams focused on delivery of new or existing internal/external programs and/or products
Develop and maintain dashboards and reports that effectively communicates results and status of projects to leadership and other internal stakeholders
Monitor Medicare legislative/regulatory changes and make recommendations on changes to internal processes to ensure readiness
Work with cross-functional teams (e.g., Medicare Medical Directors, Accounting, Finance, IT, Actuarial, Provider Network) to meet objectives
Your Knowledge and Experience
Requires a bachelor's degree or equivalent experience
Requires at least 6 years of professional experience
Must have excellent communication skills (oral, written, and presentation)
Requires ability to collaborate with and influence team members of all-levels functioning in a matrix environment
Demonstrated leadership, project management, program evaluation and consulting skills a plus
Requires proficiency with MS Office (Excel, Access, Word, PowerPoint)
Medicare experience preferred
Our Values
Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short
Human. We strive to be our authentic selves, listening and communicating effectively, and showing empathy towards others by walking in their shoes
Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals
Additional Information
About Company: o About Blue Shield of California: For more than 80 years, Blue Shield has been dedicated to transforming health care by making it more accessible, cost-effective, and customer-centric. We are a not-for-profit, independent member of the Blue Cross Blue Shield Association with 7,500 employees, more than $21 billion in annual revenue and 4.5 million members. The company has contributed more than $500 million to the Blue Shield of California Foundation since 2002 to have a positive impact on California communities. Blue Shield is headquartered in Oakland, California with 21 additional locations including Sacramento, Los Angeles, and San Diego. o Our Benefits: At Blue Shield you can expect a comprehensive benefits program that offers choice and flexibility for our diverse workforce. These programs and resources include: Medical, Dental, and Vision plan benefits, 401(k) with employer match, paid time off (PTO), earned sabbatical time, paid nonprofit volunteer time, flexible work program, free online education, tuition reimbursement, a wellness reimbursement program, 12 weeks paid parental leave, and more.
Physical Requirements: Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day. Please click here for further physical requirement detail.
EEO Footer: o EEO Footer: All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, state and local laws. External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. o Accommodations: Blue Shield is committed to providing access, equal opportunity, and reasonable accommodation for individuals with disabilities in employment, services, programs and activities. To request a reasonable accommodation prior to your interview, please contact RehabWest, Inc at (760)759-7500.
