Location: Columbia, MD preferred
Consortium Health Plans (www.consortiumhealthplans.com) is an independent company that focuses exclusively on its member / owner Blue Cross Blue Shield Plans’ national account growth efforts. Today, BCBS Plans serve more than 27 million total national account members, which represents over a quarter of the 103 million total Blue Cross Blue Shield members (one in three Americans).
Consortium Health Plans strives to position Blue Cross Blue Shield Plans as the preferred carrier of national accounts. Of the 27 million national account members covered by BCBS Plans, nearly 25 million (92%) hail from Consortium’s 21 member Plans.
Consortium Health Plans is proud of its team of experts in healthcare, technology, software development, data and analytics, actuarial science, underwriting, sales and marketing, and communications. Consortium’s executive leadership team encompasses a broad range of expertise, from strategic planning, benefits consulting, clinical delivery and data analytics, to sales and account management, marketing, and staff development.
Assist member Plans in competing for new sales and retaining key accounts by utilizing robust claims analytics and tools to demonstrate the strength and economic value of Blue Cross Blue Shield networks.
Blue Cross Blue Shield Plans are seeking new innovative approaches to grow their National Account client base. Consortium Health Plans is seeking a versatile high-performer with a passion for health care who can work collaboratively with Consortium staff and member Plans.
The candidate must have a keen eye for details, intellectual curiosity, and innate problem solving-skills. The candidate will need to efficiently and accurately utilize existing analytical tools and processes, as well as data mining techniques, and actively seek opportunities to promote enhancements or adaptations in response to changing needs.
- Analyze healthcare claims, membership, and provider data for consultant data submissions, repricing, and network analyses
- Profile and conduct preliminary analyses of data to assess quality, completeness and integrity of source data.
- Deploy and enhance algorithmic modeling and data strategies to pinpoint anomalies in cost and utilization performance, data trends, and drivers of cost performance
- Partner with actuaries, analysts, and technical staff at both Consortium and member Plans to research and resolve data issues
- Identify and promote best practices in data production and review, including enhanced reporting and operational opportunities, based on results of data analysis
- Support employer-specific claims repricing
- Utilize existing tools to reprice employers’ historical claims data based on minimum data requirements and provider disruptions
- Understand, analyze, and communicate Blue and competitor network repricing savings results and trends
- Support ad hoc repricing analyses not readily handled with existing tool set
- Update and maintain Blue and competitive carrier claims and membership repricing data sets
Qualifications and Skills
- FSA or ASA credentials
- Minimum 4 years of experience in the health insurance/managed care industry
- Minimum 4 years of experience working with large, complex health care databases and developing processes to analyze and transform raw data into useful actionable information
- Experience using SQL, SAS, Excel, VBA, and other business intelligence applications to perform quantitative / statistical analyses
- Familiarity with hospital, physician, and ancillary contracting and policy payment standards
- Knowledge of CPT and ICD10 coding preferred
- Bachelor’s / master’s degree in mathematics, actuarial science, statistics, economics or equivalent experience
Attributes and Competencies
- Strong interpersonal skills and ability to interact collaboratively with internal staff and develop relationships with Plans’ staff and consultants
- Strong oral and written communications skills; ability to explain technical actuarial concepts in layman’s terms
- Detail-oriented and self-motivated to prioritize work on multiple complex projects with ongoing deadlines
- Strong organizational and process improvement skills
- Position requires extensive communication, phone and computer work
Why work at Consortium? Here are 10 great reasons:
- You will hit the ground running on your first day, and learn something new every day after that.
- We offer competitive salaries, a bonus structure, a cash balance pension, and a safe harbor 401(k).
- We have a flexible work schedule and a very generous holiday and paid time-off program.
- We value your drive to continue your education and will support eligible employees through our tuition reimbursement program.
- We are a diverse, highly credentialed group of professionals.
- We are great at what we do and are looking for smart people to join us.
- Our work has an impact on the one-in-three Americans who receive top-notch healthcare benefits through Blue Cross and Blue Shield Companies.
- As a team, we support our local community, and we support team members who raise funds for charitable causes.
- Our company is located next to the Columbia Mall, several great restaurants, the award-winning Toby’s Dinner Theatre, and Merriweather Post Pavilion, a nationally ranked outdoor concert venue.
- We offer free parking and easy access to Route 29 and I-95.