Providing more than 4.5 million Californians with access to high-quality, affordable health care.
Blue Shield of California’s mission is to ensure all Californians access 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 meeting 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 corporate citizens.
Blue Shield has received awards and recognition for being a certified Great Place to Work, the 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 strive to make a positive change across our industry and the communities we live in – join us!
The Risk Adjustment team within the Actuarial Department is hiring a Risk Adjustment, Lead-Dashboard/Project Management. The Risk Adjustment, Lead-Dashboard/Project Management 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 include monitoring changes to Medicare legislation and ensuring internal processes comply with regulatory requirements and various activities to promote the growth of Medicare and other lines of business.
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 the process of the company’s projects involving departmental or cross-functional teams focused on the delivery of new or existing internal/external programs and products
- Develop and maintain dashboards and reports that effectively communicate 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 six 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
- 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.
Office Environment – roles involving part to the full-time schedule in Office Environment. Based in our physical offices and work from home office/deskwork – Activity level: Sedentary, frequency most of the workday.
Please click here for further physical requirement detail.
Risk Adjustment Lead-Dashboard/Project Management Oakland
To apply for this job please visit bsc.referrals.selectminds.com.