Acting as an internal consultant, advocate, mentor, and change agent, plan, design, and develop the most complex and business critical software solutions, utilizing appropriate software development methodologies either individually or as part of a project team. Responsible for ensuring that browser based systems and applications meet client requirements and operate properly, using software develop

Researches, analyzes and troubleshoots information systems compliance and security issues. Identifies, validates and reports on security incidents and events based on enterprise policies and procedures. Performs forensic information security investigations involving enterprise computers, servers and/or networking infrastructure. Assists in providing security infrastructure and support for enterpri

Design, evaluate, and implement new and/or enhanced healthcare solutions to meet the market need. Ensure solutions meet state and federal regulations and compliance. File the correct product/benefits portfolio with state and federal agencies to ensure that BlueChoice can sell products/benefits in the individual and small group markets. Based on internal and external research, acts as a management

Responsible for the most complex activities associated with maintaining ledger accounts and/or for developing financial statements and/or reports. Analyzes complex financial data and/or reports on the results and/or probable implications. Compiles financial information, processes journal entries into various accounts, and/or reconciles reports and/or financial data. Description 20% Exercises acc

Assists in formulating and defining systems scope and objectives using research and basic understanding of business systems and industry requirements. Learns to conduct business process analyses, needs assessments and cost/benefits analyses for aligning operations solutions with business initiatives. Provides assistance in testing efforts and may provide security administration to application supp

Performs quality control audits to evaluate accuracy and effectiveness of departmental operations functions including, but not limited to, claims, membership, customer service/call center, workflow, processing support systems, procedures, documentation, etc. Identifies problems, analyzes cause and effect, and makes recommendations for improvements. Description 35% Conducts focused quality audits

Responsible for the supervision and maintenance of the daily functions of the following areas Utilization Review/Review Nurses, Case Management, Medical Review, Health/Disease Management, Quality Management, and/or Appeals, to include departmental staff and specialty programs. Responsible for all data collection for specialty programs and ensures appropriate levels of healthcare services are provi

Acting as an internal consultant, advocate, mentor, and change agent, plan, design, and develop the most complex and business critical software solutions, utilizing appropriate software development methodologies either individually or as part of a project team. Responsible for ensuring that browser based systems and applications meet client requirements and operate properly, using software develop

Monitor and/or reconcile assigned general ledger accounts of a complex nature, process complex accounting activity, resolve variances, and/or document procedures to ensure accuracy of accounting information and/or financial reports, and/or compliance with established rules and/or regulations. Provide functional advice and/or training to less experienced accountants. Description 30% Prepares dail

Responsible for assisting in the execution of financial, compliance, and operational audits including evaluation of internal controls. Audits the activity of various departments and providers for compliance with plans, policies, and procedures prescribed by management. Reviews assigned portions of audit programs, determines compliance with policies and procedures, recommends corrective action plan

Under general supervision, performs a variety of routine to moderately complex clerical/accounting functions such as inventory balancing, reconciliations, generating refund request letters, processing disbursements and deposits, keying journal entries and logging items in accordance with standard procedures in one or more of the following areas; general accounting, accounts payable, accounts recei

Provide system/production support and monitoring for applications, batch cycles, releases, projects, implementations, installations, etc. Participate in work sessions for system support and problem resolution. Description 30% Perform/Support installation, configuration, administration, implementation, scheduling and/or tuning/modification of applications. Provide support for simple to moderate s

Perform all phases of applications systems analysis and design. Analyze systems specifications and develop applications to support information systems processes. Prepare detailed specifications from which complex programs will be written. Design, code, test, debug, document and maintain these programs. Formulates scope and objectives through research to develop or modify complex systems. This posi

Provides education to medical providers as warranted. Description 25% Communicates/educates providers on issues such as Medicare coverage, utilization statistics, documentation and medical review by use of written advisories, reports, letters, and telephone contacts. Documents all provider contacts/communications in provider tracking system. 20% Conducts formal conference calls and/or in person

Intern position utilized for training an active college student towards a professional level role. Responsibilities vary and are based upon the needs of the area and the experience of the incumbent at the time of employment. This incumbent works under direct supervision and has responsibilities for performing entry level tasks and for learning professional level tasks relating to area operations.