Job Description:

Job Responsibilities

• Developing predictive data models, quantitative analyses and visualization of targeted, big data sources.
• Overseeing the acquisition and ingestion of data from structured and unstructured sources, while ensuring quality and comprehensiveness of data.
• Leading data exploration and analytic projects and providing on-going coaching of big data topics (visualization, data mining, analytic techniques).
• Exploring and implementing semantic data capabilities through NLP, text mining and machine learning techniques.

Job Qualifications

Education

• Undergraduate bachelor’s degree in any discipline with 8 years working experience in managed care/health care claims/ pharmaceutical claims data is required (student jobs do not qualify), OR Master's Degree with 6 years experience, OR Ph.D. with 4 years experience is also acceptable. Quantitative/research discipline preferred but not required (e.g., Biostatistics, Biology, Statistics, Mathematics, Economics, Computer Science, Quantitative Social Sciences, Information Systems).

Experience

• 1 year - Experience with SAS (Base, SQL, Enterprise Miner, Guide) or similar experience with programming and/or statistical analysis required

SkillsCertifications

• Ability to comprehend technical instructions and explain/breakdown problems and issues
• Understanding of planning/design principles and the application of these principles in a planned environment
• Ability to work independently under general supervision and collaboratively as part of a team in a fast paced environment
• Must be a team player, be organized and have the ability to handle multiple projects
• Excellent oral and written communication skills
• Excellent interpersonal and team building skills
• Working knowledge of statistics and research design

Job Specific Requirements: 

Position Overview:

This position will play a key role in wide-ranging analysis and initiatives related to claims payment, ensuring that processes, data, and benchmarks accurately reflect negotiated provider rates, bundled services, and other related factors. It will involve extensive collaboration with other business areas and external entities as well as direct data analysis.

Preferred Qualifications:

In this role, of the major activities listed above, Utilization and Cost Studies and Network Evaluation will receive greater emphasis than more clinically oriented activities such as Program Evaluation and Outcomes Assessment.

Additional Position Responsibilities: 

• Support of internal reporting/analytics

• Lead governance-related activities

• Mine for data anomalies

• Monitor and maintain data mapping, reference tables and other rules

• Guide development of a dashboard tracking tool or other methods of internal monitoring.

• Perform methodology comparisons, coding review, data validation

• Identify and drive internal improvements

• Track, evaluate, disseminate, and develop action plans on findings and recommendations

• Responsible for plan-specific deep-dive analytics and recommendations  

• Responsible for exploration and assessment of findings from external tools and resources

• Participate in relevant training sessions and share key excerpts internally

• Support for plan-specific logic and “special handling”

• Identify and evaluate best practices

Preferred Skills:

Number of Openings Available:

Worker Type:

Company:

Remote-First Statement:

BCBST is a remote-first organization with many employees working primarily from their homes.  Each position within the company is classified as either fully remote, partially remote, or office based.

BCBST hires employees for remote positions from across the U.S. with the exception of the following states:  California, Massachusetts, New Hampshire, New Jersey, and New York.  Applicants living in these states may move to an approved state prior to starting a position with BCBST at their own expense.  If the applicant moves to Chattanooga, TN, they may be eligible for relocation benefits.

Applying for this job indicates your acknowledgement and understanding of the following statements:

BCBST is an Equal Opportunity employer (EEO), and all employees and applicants will be entitled to equal employment opportunities when employment decisions are made. BCBST will take affirmative action to recruit, hire, train and promote individuals in all job classifications without regard to race, religion, color, age, sex, national origin, citizenship, pregnancy, veteran status, sexual orientation, physical or mental disability, gender identity, or any other characteristic protected by applicable law.

Further information regarding BCBST's EEO Policies/Notices may be found by reviewing the following page:

BCBST's EEO Policies/Notices

BlueCross BlueShield of Tennessee is not accepting unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee at BlueCross BlueShield of Tennessee via-email, the Internet or any other method without a valid, written Direct Placement Agreement in place for this position from BlueCross BlueShield of Tennessee HR/Talent Acquisition will not be considered. No fee will be paid in the event the applicant is hired by BlueCross BlueShield of Tennessee as a result of the referral or through other means.

Tobacco-Free Hiring Statement

To further our mission of peace of mind through better health, effective 2017, BlueCross BlueShield of Tennessee and its subsidiaries no longer hire individuals who use tobacco or nicotine products (including but not limited to cigarettes, cigars, pipe tobacco, snuff, chewing tobacco, gum, patch, lozenges and electronic or smokeless cigarettes) in any form in Tennessee and where state law permits. A tobacco or nicotine free hiring practice is part of an effort to combat serious diseases, as well as to promote health and wellness for our employees and our community. All offers of employment will be contingent upon passing a background check which includes an illegal drug and tobacco/nicotine test.  An individual whose post offer screening result is positive for illegal drugs or tobacco/nicotine  and/or whose background check is verified to be unsatisfactory, will be disqualified from employment, the job offer will be withdrawn, and they may be disqualified from applying for employment for six (6) months from the date of the post offer screening results.

Resources to help individuals discontinue the use of tobacco/nicotine products include smokefree.gov or 1-800-QUIT-NOW.