Director HCV Business Configuration

With more than 7,000 employees, we are the largest health insurance company in Michigan. We offer an exciting work environment with a diverse group of employees. Our goal is to make health insurance easier for our members. We want to transform the industry and become a resource that people can trust.

Southfield, MI

Blue Cross Blue Shield of Michigan

When you think of <a href="" target="_blank" rel="noopener noreferrer">Blue Cross Blue Shield of Michigan</a> for health insurance, you can know you&rsquo;re getting much more. We're a company founded on a tradition of affordable, quality health care for everyone, improving the present and investing in the future.&nbsp;<br /><br />We offer:<br />Plans for employers and individuals that meet today&rsquo;s needs, budgets and lifestyle<br />The largest network of doctors and hospitals in the state<br />Lower health care costs Higher quality health care<br />Award-winning diversity practices<br />Grants and programs that promote better health throughout Michigan<br /><strong><br />Mission:&nbsp;</strong>We commit to being our members&rsquo; trusted partner by providing affordable, innovative products that improve their care and health.<br /><br /><a href="" target="_blank" rel="noopener noreferrer"><strong>Click here</strong></a> to learn more about our commitment to our Social Mission, view company updates and reviews, and view our awards &amp; accolades.<br /><br />For Application Timeline &amp; Selection Process:&nbsp;<a href="" target="_blank" rel="noopener noreferrer">Click Here</a>. Learn more about your options as an external candidate. <a href="" target="_blank" title="BCBSM" rel="noopener noreferrer">Click here</a> to view open positions.

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Competitive Total Compensation Package

Overview: Responsible for delivering configuration strategy and operations management to support business-driven requirements from various areas of the organization. Consult, plan, and execute on provider data needs, as well as commercial PPO pricing and risk contracts. Responsible for departmental leadership including setting strategic direction and implementation of strategies for analyzing, developing, configuring, and testing the technical system configuration for Portico and NetworX and other integration business applications. Provide oversight for implementation and testing of new system rules related to system fixes and new releases.
Responsibilities: <ul> <li>Develop and direct the processes of the Portico and NetworX Pricer configuration development lifecycle including oversight of requirements&rsquo; analyses, creation of alternative system build options, business communication, system table construction, testing and implementation into production for PPO pricing, provider data configuration, Facets interface rules, CAQH data, and provider data automation.</li> <li>Coordinate resolution of production defects using standard system methodologies, including break/fix process controls, analysis, testing, coordination with other IT areas and owners of third-party integrated systems, and coordination of migration of changes into production</li> <li>Administer departmental quality controls; develop and maintain reports and tools surrounding the integrity and validity of the business rules in Portico and NetworkX tables, ensuring that all activities follow industry standards and are in compliance with audit standards.</li> <li>Oversee new build, system maintenance, break/fix, and release activities between Change Healthcare, Cognizant, CAQH, and BCBSM.</li> <li>Coordinate with key business areas relative to Portico and NetworX Pricer functionality and other interfacing applications to identify opportunities for increased operational efficiencies</li> </ul>
Requirements: <ul> <li>Bachelor's degree required. Master's degree preferred.</li> <li>Eight (8) years of experience in systems project management and business solutions or related experience.</li> <li>Three (3) years of leadership experience.</li> <li>Experience in relationship database reporting, structures, and SQL languages.</li> <li>Knowledge of all components of health care industry, including membership, customer servicing, claims, provider, product, and financial entities.</li> <li>In-depth knowledge of system implementation, quality control and testing methodologies.</li> <li>Demonstrated knowledge of audit and control methods, as well as IT and systems analysis methods.</li> <li>Proven project management skills.</li> <li>Advanced proficiency with current industry standard PC word and spreadsheet applications (Excel and Access).</li> <li>Effective organizational, analytical planning and problem-solving skills.</li> <li>Ability to effectively manage multiple workloads to meet competing priorities.</li> <li>Excellent written and verbal communication skills.</li> <li>Excellent interpersonal skills with the ability to lead and work effectively in a team environment.</li> </ul> <div id="gtx-trans" style="position: absolute; left: -311px; top: 26.7639px;">&nbsp;</div>