Medical Value Analyst II at Capital Blue Cross

Harrisburg, Pennsylvania, United States -

Full Time

Start Date

Immediate

Expiry Date

14 May, 26

Salary

0.0

Posted On

13 Feb, 26

Experience

0 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Data Analysis, Value Based Programs, Accountable Care Arrangements, Reporting Requirements, Issue Resolution, Query Intake, Self-Service Tool Requirements, Industry Research, Project Planning, Communication, Negotiation, Teamwork, Consultative Solutions, Data Modeling, SAS, Tableau

Industry

Insurance

Description

Position Description Base pay is influenced by several factors including a candidate’s qualifications, relevant experience, and anticipated contributions to meet the needs of the business, along with internal pay equity and external market driven rates. The salary range displayed has not been adjusted for geographical location. This range has been created in good faith based on information known to Capital Blue Cross at the time of posting and may be modified in the future. Capital Blue Cross offers a comprehensive benefits packaging including Medical, Dental & Vision coverage, a Retirement Plan, generous time off including Paid Time Off, Holidays, and Volunteer time off, an Incentive Plan, Tuition Reimbursement, and more. At Capital Blue Cross, we promise to go the extra mile for our team and our community. This promise is at the heart of our culture, and it’s why our employees consistently vote us one of the “Best Places to Work in PA.” The position conducts and participates in activities related to designing, planning, and overseeing initiatives led by the Network Analytics and Pricing (NAP) Department. The analyst understands and helps to execute Value Based Operations Unit objectives and works in collaboration with internal business and analytical units to define business requirements and develop analytical end products to support the business objectives. The analyst must use knowledge of existing business practices, systems, procedures, and policies to provide innovative approaches and solutions to business problems. Responsibilities and Qualifications Analyze data to assist in the design of our Value Based Programs (VBP) - including accountable care arrangements, medical neighborhoods, and other value-based Initiatives. Work with senior business analyst to develop analytic and/or report requirements that support their ability to make informed decisions regarding strategy initiatives/objectives, and/or appropriate tactical level actions. Work within the Network Analytics and Pricing (NAP) Unit to help identify, research, and resolve operational and other business issues relating to the value-based programs and initiatives. Intake queries from physician practices related to reports and process flows associated with VBP and initiatives (i.e., provide first line of support), refine requirements and coordinate responses from informatics and reporting resources. In collaboration with informatics and reporting functional areas and information technology experts, assist in establishing self-service tool requirements that allow for the efficient production of reports and analyses. Develop an understanding of various company information assets to leverage for use in the VBP activities. Research and understand industry best practices in payment reform and accountable care organizations pilots/initiatives that are being undertaken by other health plans. Leadership: Ability to plan, organize, lead and control projects and work teams. Includes the ability to effectively communicate in writing and verbally with technical and non-technical audiences. Also includes persuasion and negotiation skills to resolve differences with skill and understanding. Ability to lead meetings and give presentations to both management and staff. Includes the ability to develop teamwork among diverse groups. Ability to leverage knowledge and skills to provide consultative solutions to business challenges. Knowledge: Knowledge of the health care industry and Capital corporate structure. Includes knowledge of standards, policies, and business practices and procedures for multiple departments/systems. Is familiar with those business services, systems and/or processes provided by external business partners. Knowledge of terminology and concepts in the health insurance space, including key concepts from health reform and its implications on payer-provider relationships. Knowledge of data processing terminology and concepts. Includes a technical understanding of technologies such as Microsoft Office Suite, Data Modeling, SAS, Theon tools, Tableau, CRM, and Intranet Technology. Skills: Ability to analyze problems and issues, determine impact, and develop business solutions. Ability to function as a liaison and recommend solutions to a variety of departments, as well as other Plans and other external business partners. Ability to quantify and prioritize assigned activities; ability to adapt to changing priorities; and ability to perform duties with minimal supervision. Includes ability to act both independently and as part of a team. Experience: Minimum 2 years’ experience working with data analytics tools such as SAS, Tableau and/or Power BI. Familiar or experienced in healthcare systems that are peripheral to Facets or other Operational Support (OS) support system configuration. Education, Certification, and Licenses: Prefer a bachelor’s degree in one of the following: business administration, health planning and administration, information systems, computer science; or in lieu of degree minimum 2-3 years of related experience. Work Environment: Working environment includes typical office conditions. Physical Demands: While performing the duties of the job, the employee is frequently required to sit, use hands and fingers, talk, hear, and see. The employee must be able to work over 40 hours per week. The employee must occasionally lift and/or move up to 5 pounds. About Us We recognize that work is a part of life, not separate from it, and foster a flexible environment where your health and wellbeing are prioritized. At Capital you will work alongside a caring team of supportive colleagues, and be encouraged to volunteer in your community. We value your professional and personal growth by investing heavily in training and continuing education, so you have the tools to do your best as you develop your career. And by doing your best, you’ll help us live our mission of improving the health and well-being of our members and the communities in which they live.

Responsibilities

The analyst will conduct and participate in activities related to designing, planning, and overseeing initiatives within the Network Analytics and Pricing Department, focusing on executing Value Based Operations Unit objectives. Responsibilities include analyzing data for Value Based Programs, developing analytic requirements, and resolving operational issues related to these initiatives.