Responsible for providing a full range of financial, compliance, and operational audits, business advisory, and consultation services, investigations, internal controls, accountability, and use of resources. Description 50% Conducts internal and/or external timely operational, financial, and/or compliance audits of divisions, departments, providers, and activities of the corporation including ev

Lead and direct the creation/execution of the strategic plan and ensures goals are met in accordance with the plan. Responsible for the coordination and direction of operations, including administration of staff, reporting and strategic development. Description 40% Directs multi functional area handling but not limited to customer service, claims, membership, client support, appeals, training, c

As member of the senior management team, provides administrative oversight to the medical staff, analyzes medical review utilization data, researches new medical procedures or technology, and acts as a resource to providers and internal staff on issues concerning medical policies. May also write and revise medical policies. Description Supports operations in the form of case review on both medic

Conducts market, product, and competitor research to be used in the development of new products. Collects and analyzes market data and provides management with reports. Description 30% Manages multiple projects which involve coordination of benefit set up, eligibility feeds, process improvements, coordination of deadlines, launch tracking, etc. Responsible for third party monthly invoicing, trac

Description 30% Prepares daily and/or monthly account reconciliations of a complex nature. Ensures work conforms to all contract/business regulations and/or instructions as well as generally accepted accounting principles, federal acquisition regulations, cost accounting standards and/or departmental policies. 30% Reviews, analyzes, and/or verifies complex accounting and/or system transactions. I

Responsible for analysis, design, programming, and implementation of complex applications tasks and projects. Devise feasible, logical procedures to resolve business problems through the use of computer resources. Formulate scope and objectives through research to develop or modify complex systems. Review detailed specifications and recommend modifications. Design, code, test and debug complex app

Defines customer needs in technical and business contexts. Ensure the proposed technical and business solutions meet the customer's objectives for the work effort. Description 50% Elicit and document user requirements to meet a business objective. Identify and validate requirements and organize the information into a logical document that is understood by the customer and Information Systems. 25

Administer all phases of the 3R process (relocation, renovation and rearrangement) from inception to completion including selecting, scheduling, directing and coordinating the activities of external vendors. Direct and coordinate all activities related to moves within the corporation, including formulating policies and participating in planning. Administer space planning guidelines and interprets

Oversees the accurate processing of claims that have been deferred for medical necessity review. Ensures compliance with nationally recognized standards, and local, state, and federal laws and regulations. Identifies and implements process improvement opportunities. Description 70% Manages the medical review process. Maintains a well trained staff. Develops/implements medical review strategy wit

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

Provides care management services to more than 2 million members in South Carolina and nationally. Administers complex, high touch concierge case management for members identified into specialized programs such as high risk maternity, NICU, ESRD, Palliative Care Behavioral Health. Identifies risks and provides outreach services to facilitate the coordination of healthcare services and gap closure.

Summer 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 opera

The incumbent is expected to successfully complete the course curriculum for BlueCross' IT Entry Level Training Program (ELTP). Classroom training will focus on web/application development, system support, infrastructure or IT risk and compliance. On call will be required for some positions. Positions require a security clearance, which requires US citizenship to obtain. Description 50% Partici

Provides care management services to more than 2 million members in South Carolina and nationally. Administers complex, high touch concierge case management for members identified into specialized programs such as high risk maternity, NICU, ESRD, Palliative Care Behavioral Health. Identifies risks and provides outreach services to facilitate the coordination of healthcare services and gap closure.

Diabetes Free SC (DFSC) is a new program implemented by BlueCross BlueShield of South Carolina (BCBSSC). It is charged with confronting diabetes to benefit the whole population of South Carolina, with a special emphasis on the underserved and minority communities. DFSC guiding principles include (i) aligning and developing existing efforts against diabetes, and (ii) achieving statewide scale. Reco