Job Description

Your Role

The Provider Dispute Resolution (PDR) team manages and processes provider disputes across the Commercial, Medi-Cal and Medicare lines of business. The team also partners with an offshore vendor to complete provider disputes and other strategic projects. The Business Analyst, Consultant will report to the Director of PDR. In this role you will work closely with the CalPERS product and account management team as well as the Commercial PDR team to develop strategy for the CalPERS product line and Commercial line of business. This role will also convert data obtained from various internal systems into actionable insights to guide business decision making for the PDR and CalPERS teams.

Your Work

In this role, you will:

• Provide highly complex analytical support through the analysis and interpretation of data in support of cross-functional business operations
• Lead the development of annual operating plans, capital budgets and forecasts, and build business cases for new business initiatives (cost/benefit analysis)
• Develop, prepare, and analyze reports with highly complex analysis and data for management review, and presents to various levels of management
• Define business requirements and provide analysis to increase operational efficiency 
• Provide analytical support for multiple, highly complex cross-functional projects simultaneously, establish work plans and timelines, coordinates with internal and external resources
• Coordinate interaction between Data and Analytics teams and business Subject Matter Experts for clarity of requirements definitions 
• Use Agile methods to deliver data and reporting solutions
• Present in Operational Committees, trend top drivers of provider disputes, and work with upstream and downstream partners to reduce provider pain points
• Partner with PDR Regulatory Audit Manager and Operations managers in developing new procedures and guidelines for onshore and offshore PDR teams that are aligned with regulatory requirements

Your Knowledge and Experience

• Requires a bachelor’s degree or equivalent experience
• Requires at least 7 years of prior relevant experience
• Requires experience validating the quality and integrity of incoming data
• Requires prior experience in data analysis and reporting, including Excel, SQL, BI tools, and data visualization
• Requires excellent communication, presentation, and interpersonal skills, with the ability to communicate complex technical concepts to both technical and non-technical audiences
• Requires expertise in at least one of the following lines of business – Commercial, Medi-Cal and/or Medicare

Pay Range:

The pay range for this role is: $ 96470.00 to $ 144760.00 for California.

Note:

Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.

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