Current Career Opportunities

Responsibilities

• Support the development of financial projections, reports, and actuarial analysis for well defined projects as directed. 
• Compile and evaluate statistical data.
• Participate in related activities and projects as directed.

Qualifications

• Student Track:
  • BS in Actuarial Science, Mathematics, Statistics or a closely related field required.
  • Level I: Minimum of one course of the Society of Actuaries exams.
  • Maintain student status according to the Blue Cross Actuarial Student Program.
• Non-Student Track
  • BS in Actuarial Science, Mathematics, Statistics or a closely related field required.
  • 1-3 years of closely related experience.
  • Strong computer knowledge (including programming, Access, Excel, SAS and/or SQL).

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Assistant General Counsel Responsibilities:

• Research and analysis of complex legal issues, transactions, contracts, and other documents presented by all departments of the Corporation and its affiliates.

• Develop and review contractual provisions, and interpret and advise the Corporation on state and federal laws and regulations (including state and federal laws relating to health insurance companies).

• Respond to inquiries regarding state and federal legislation, and keep the General Counsel informed of matters having a legal impact on the Corporation.

• May serve as the Privacy Officer.

Assistant General Counsel Qualifications:

• Graduate of an accredited law school, holds JD degree.
• Admitted to practice before the Vermont Bar.
• 1 – 5 years’ experience in a law firm or corporate law department; experience in complex contracting, health care or insurance industry strongly preferred.

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Associate Actuary Responsibilities

• Provide analysis and support for the design and administration of the risk adjustment program. 
• Collaborate cross-departmentally to develop key metrics, analyses, and reporting to support the company’s growth initiatives.
• Recommend policies and procedures to protect the company’s financial integrity.
• Provide guidance and mentoring to more junior team members.

Associate Actuary Qualifications

• BA/BS in Actuarial Science, Mathematics, Statistics, Finance, Health Information Management, closely related field, or equivalent experience required.
• Associate of Society of Actuaries (ASA) required.
• Minimum of 3 to 5 years of experience in actuarial science or data analysis and reporting in a healthcare setting.
• Requires proficiency in Microsoft Excel and SAS (or SQL)
• Prior experience with risk adjustment required
• Prior knowledge of dashboard development and data visualization preferred

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Responsibilities:

• Create adoption for our plans, products, services, and programs through effective positioning and promotion with our small and large groups (B2B) clients and prospective clients.
• Strategize, plan, create, and coordinate marketing communications initiatives as well as create consistent positioning statements that will be used by the brand and engagement team (B&E), product, and sales, teams to implement marketing communications strategies.
• Work closely with creative designers, ad agencies, and other external partners. 
• Consider various channels available to promote specific products as well as understanding shopping behaviors, audience segmentation, and what consumers need to live well. 
• Work closely with the Manager, Brand & Communications Strategy to understand new business opportunities that will support the organization when it needs to change direction related to products and services.
• Participate in developing plans, and monitor processes that measure, assess, and improve the quality of member and group materials.

Qualifications:

• Bachelor’s Degree or equivalent experience in Marketing or related field.
• Minimum of 7 years of marketing communications experience. 
• Product marketing experience required.
• Must be experienced in the creative development of advertising, direct marketing, internal and external communications, and online marketing to members, consumers, providers and clients.
• Health care industry expertise or other regulated industry experience a plus.

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Claims Analyst Responsibilities:

• Review all claims data submitted for accuracy and completeness
• Analyze claims to determine appropriate coding for processing. Determine if procedure code is payable according to particular line of business.
• Review provider pricing files to determine allowances for correct payment.
• Review, investigate and resolved suspended claims relying on department procedures, using system files as necessary.
• Determine the correct level of coding and/or reimbursement for claims relying on department procedures, using system files as necessary.

Claims Analyst Qualifications:

• High school diploma or equivalent is required.
• Strong data entry skills required.
• Knowledge of medical terminology and medical coding strongly preferred.

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Responsibilities

• Manage and implement a variety of clinical quality assurance and improvement activities including quality of care investigations and interventions, medical record reviews, and accreditation/regulation compliance activities.  
• Act as a consultant to other departments engaged in quality improvement activities, with a particular focus on the medical services and provider relations areas.
• May work with key players in the health care delivery system, including other plans, state agencies, and provider groups, to develop and implement improvement strategies across the system.

Qualifications

• BS/BA degree in nursing and current Vermont Registered Nurse license required.  
• Strong computer skills, including Microsoft Word, Excel, PowerPoint.
• Project management experience required. 
• Knowledge of Vermont health care community and clinical protocol for preventive, chronic, and acute care required.
• Knowledge of quality improvement methods and concepts, including NCQA and URAC standards, desired. Familiarity with Vermont managed care regulatory requirements desired.  
• This position requires occasional travel throughout the state of Vermont.   Valid driver’s license and own car is required for travel.

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Clinical Support Representative I Responsibilities:

• Complete a training program comprised of mentoring and on-the-job training that provides the Representative with the technical knowledge, analytical, and Customer Service skills needed to accurately process prior authorizations and other authorizations and requirements. 

• Provide accurate, prompt, and courteous responses to phone and written inquiries and to consistently provide outstanding customer service. Examples of such inquiries include, but are not limited to prior authorization questions and requirements, authorization issues such as requests or status checks, and initiating next steps for denied authorizations, underwriting guidelines, and internal policies and procedures.

• Contribute to excellent customer satisfaction by providing information and initiating appropriate corrective actions to resolve inquiries based on a comprehensive understanding of BCBSVT contracts, policies, systems, and procedures.  

Clinical Support Representative I Qualifications:

• High school graduate or equivalent required. 
• Analytical and critical thinking skills required.
• Computer literacy and strong typing and spelling skills required. 
• One to two years of successful customer service experience, preferably in a health insurance or health care setting is desired.
• The ability to multitask, problem solve, and work independently is necessary.

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Our Customer Service positions provide:

• Starting pay at $19.00 per hour with multiple promotional opportunities within the first two years.
• Remote Work: Blue Cross has transitioned to a hybrid workplace where employees within driving distance of our Berlin, VT office work two days per week in the office with flexibility to work remotely the rest of the week. Vermonters who live further than 70 miles from our Berlin, VT office can work remotely full-time.
• Biannual department retention bonus program, annual corporate incentive bonus program and additional compensation opportunities throughout the year.
• 8-week paid training on all facets of the health care industry.

Target start date of Wednesday, November 16.

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Data Architect Responsibilities:

• Work as part of a distributed team within IT to help create, enrich and move data throughout the Enterprise. 
• Help improve consistency, quality, security, and delivery of the data. 
• Create data flows to optimize cost management in a hybrid cloud environment. 
• Create and assess architectural models and supervise migrations across on-prem, Iaas, Paas and Saas systems.

Data Architect Qualifications:

• BS/BA in an IT related discipline or equivalent work experience required. 
• 10+  years of experience in business and IT, preferably in a healthcare environment 
• 3+ years of architecture practice experience
• Familiarity of system concepts and tools within an enterprise architecture framework that includes data lakes and storage patterns, etc.
• Persuasive in influencing strategic architecture direction, framing reference architectures, specifying policies and standards, drive consensus on target state architectures, and influence roadmaps
• Excellent written and verbal communication skills 
• Proven analysis and critical thinking skills 

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Responsibilities:

• Provide administrative support services to three members of the Executive Staff and directors within their divisions, as needed and time allows.  
• Work in a well coordinated team environment to support an efficient, smoothly functioning, professional, and highly confidential work environment for executives, directors within their divisions, members of the Board of Directors, and other members of the Blue Cross community.
• Provide specialized administrative functions for three assigned Vice Presidents and directors within their divisions, as needed and time allows, as a key element of the job.  
• Provide back-up support for other members of the Executive Staff.

Qualifications:

• AS degree or equivalent education required.  
• Three to five years of administrative assistant experience, preferably in a professional office environment, required.

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Help Desk Analyst I Responsibilities:

• Facilitate the prompt and effective resolution of technical and production issues for all workforce members of Blue Cross.

• Use judgment, analysis, and initiative to resolve problems, make recommendations based on corporate standards, and deliver impromptu end-user operational assistance as needed.

• Maintain communications with requestors throughout the analysis and resolution process particularly in higher severity incidents, keeping them informed of status and escalating issues if deemed necessary. 

• Identify systemic issues (e.g., system outages, widespread processing errors) and take ownership of the end-to-end process to optimize the customer experience.

Help Desk Analyst I Qualifications:

• Minimum Associates Degree in computer science or a related field; Bachelor's degree preferred.
• In-depth knowledge of computer systems and mobile devices 
• Hands on experience with diagnosing and resolving basic technical issues
• Excellent communication and interpersonal skills, customer-oriented and patient

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Lead Cybersecurity Engineer Responsibilities:

• Architect/design, evaluate, implement and maintain security appliances and systems implemented within the company’s environment as well as our Public Cloud instance(s). 

• Provide customer support for both internal and external users

• Provide escalation support, such as defining and implementing policy changes to security control rule-sets, troubleshooting security systems, and other related tasks as necessary to support the operations.

• Requires a strong knowledge of the following areas:

  • Security Information & Event Management (SIEM) technologies

  • Data Loss Prevention (DLP)

  • Web content filtering

  • SSL inspection

  • Multi-Factor Authentication

  • Intrusion Detection System (IDS) / Intrusion Prevention System (IPS)

  • Advanced Persistent Threat (APT) systems

  • Vulnerability management

  • Firewall technologies

  • Endpoint detection & response (EDR) technologies

  • Cloud Security (IAAS, PAAS, SAAS)

  • Data life-cycle protection

  • Network-segmentation & micro-segmentation

  • Security orchestration & automation response (SOAR)

  • DNS Security and Network Access Control (NAC)

  • Knowledge of Windows and Linux based operating systems in a highly virtualized environment is preferred. 

Lead Cybersecurity Engineer Qualifications:

• Required Bachelor of Science degree.
• Consideration will be given to candidates who possess 6+ years of experience in information systems and information systems security, with a strong focus on good information security practices. 
• Candidates must have a nationally recognized information systems security certification, such as CISSP, GIAC, CERT, or SANS certification(s).
• Candidates must also have obtained specific technology certifications such as Check Point CCSE, CCSA.  Coursework toward a recognized certification will be considered.

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Licensed Practical Nurse - Wellness Coordinator Responsibilities:

• Serve as the primary point of contact for Blue Cross's low-risk maternity wellness population and low-risk chronic condition population, including some mental health and substance use disorder cases.
• Interact and collaborate daily with team members, providers, internal and external vendors, members and families to provide a complete continuum of care. 
• Demonstrate value through member engagement and constant adherence to evidence-based guidelines and quality standards. 
• Collect data and complete screenings to identify needs, escalating issues to other Blue Cross clinicians as needed, and provide clients with education and effective connection to resources.

Qualifications:

• High School diploma required; higher degree preferred.
• Vermont LPN license required.
• 3-5 years of clinical experience required.  
• Experience working with maternal and chronic condition and/or mental health populations preferred.
• Strong oral and written communication skills required.

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Provider Engagement Consultant Responsibilities:

• Serves as the primary point of contact, consultative resource and subject matter expert in all aspects of coding and medical record documentation requirements as they apply to Risk Adjustment.
• Review medical records for coding and documentation accuracy, completeness and specificity.
• Educate practitioners and office staff, to include the creation of trainings, that relate to Risk Adjustment and Hierarchical Condition Category (HCC) best practices.
• Audit the coding accuracy of vendors. 
• Prepare and present reports on program activities and performance metrics to internal and external stakeholders. 
• Follow up on internally developed Corrective Action Plans to correct issues found by the federal government for rules and/or regulations infractions related to Affordable Care Act (ACA) or Medicare Advantage (MA) risk adjustment.

Qualifications:

• Nursing degree or other medical degree strongly preferred.
• Minimum of two years of clinical/coding practice experience in a provider’s office, hospital setting, or comparable setting required.
• One of the following certifications required: Certified Documentation Information Specialist (CDIS), Certified Clinical Documentation Specialist (CCDS), Coding Certification Specialist (CCS or CCS-P), Certified Professional Coder (CPC), Certified Risk Adjustment Coder (CRC), with minimum of two years’ experience using certification in the workplace.
• Experience working with Hierarchical Condition Categories (HCCs) preferred.

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Responsibilities:

• Provide sales and support for the following Blue Cross products: Qualified Health Plan (QHP) Individual & Small Group and Medicare market. 

• Support marketing and sales initiatives for individual products including non-group products, such as Qualified Health Plans, Medicare Supplemental, Medicare Part D (PDP) and Medicare Advantage.

• Maintain a positive, supportive, proactive relationship with brokers, clients, and customers. 

• Market and sell Blue Cross individual and group products to prospective customers. 

• Meet assigned sales and retention quotas for Small Group, Individual QHP, Medicare Supplemental, Medicare Part D (PDP), and Medicare Advantage.

Qualifications:

• High School Diploma or equivalent

• 2-5 years’ experience required in HMO or health insurance sales, customer service, marketing or marketing related duties required.  

• Valid Vermont driver’s license with good driving record

• Current Vermont Producer’s license Accident and Health required within 3 months of hire into the role.  

• Willingness to travel throughout Vermont as necessary.

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Senior Actuarial Analyst - Risk Adjustment Responsibilities

• Provide analysis and support for the design and administration of the risk adjustment program. 
• Collaborate cross-departmentally to develop key metrics, analyses, and reporting to support the company’s growth initiatives.

Senior Actuarial Analyst - Risk Adjustment Qualifications

• BA/BS in Actuarial Science, Mathematics, Statistics, Finance, Health Information Management, closely related field, or equivalent experience required
• Minimum of 5 to 7 years of experience in actuarial science or data analysis and reporting in a healthcare setting
• Requires proficiency in Microsoft Excel and SAS (or SQL)
• Prior experience with risk adjustment required
• Prior knowledge of dashboard development and data visualization preferred

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Senior Medical Director Responsibilities:

• Develop clinical program strategy for business units throughout the organization, providing clinical direction for business decisions, while understanding the impacts upon our members and providers within the context of the organization and state/federal regulatory guidelines and quality requirements. 
• Provide clinical validation of existing programs based on market research and competitive differentiation and actively seek to enhance and/or develop new programs. 
• Assist the plan to innovate and actively alter existing and outdated health paradigms and close the gaps in our members’ health journeys to improve their overall state of health and maximize their member experience. 

Senior Medical Director Qualifications:

• Based on leadership and infrastructure requirements of Vermont State Law, URAC, and NCQA, possession of an unrestricted Vermont medical license, American Specialty Board certification, and 5 - 7 years clinical practice experience combined with 3 - 5 years of clinical management experience is required. 
• Prior medical administrative background is highly desirable. 
• Advanced management degree or equivalent preferred.

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Responsibilities:

• Uncover user behaviors, needs and motivations to make products, services and tools more intuitive and engaging for users.
• Using qualitative and quantitative methods, influence the development, design, and implementation of products, services, tools, marketing materials, digital channels, and more. 
• Collect and analyze user behavior in several ways, including but not limited to: surveys, usability testing, ethnographies, benchmark studies, server logs, eye tracking studies, and more, using both in-house resources and external third party resources.  
• Help advocate your research findings to diverse audiences through written reports and in-person presentations. 
• Work closely with a variety of internal customers – brand, communications, digital, product, sales, and more.
• Work closely with the Manager of Market Strategies to determine research needs within the company, identify knowledge gaps in our understanding of the experience, and contribute to solving for those gaps.  

UX Researcher Qualifications:

• BA/BS in Psychology/HCI/Interaction Design or a related subject
• 4+ years' industry experience in research design and conducting user research studies across platforms

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The case manager utilizes a collaborative process of assessment, planning, facilitation, and advocacy in the case management process to coordinate health care benefits to meet individual members' health needs through communication and targeted intervention to promote optimal, cost-effective outcomes. The case manager works collaboratively with members, families, and providers and draws on a strong knowledge base involving clinical standards and expertise, insurance plans and products, and other benefits and funding resources to arrange or coordinate services that the member needs to get well, stay well or live with their illness, and helps to remove barriers that prevent the member from engaging in an appropriate plan of care. 

This position participates in the continued development and enhancement of all aspects of the case management process, the development and coordination of services within the department, and the understanding and integration of department business objectives and measures The case manager applies the principles and core technology of case management to members across various product lines, benefits, demographics, conditions, and programs.

Qualifications

• Licensed clinician in the state of Vermont
• Masters of Social Work or Psychology or graduate of an approved program in professional nursing
• RN required, BSN or MSN desired.
• Minimum 5 years of varied clinical practice experience required with a minimum of 2 years of direct clinical practice.
• 1-3 years of case management experience desired. CCM preferred and encouraged when eligible.  Evidence based health coaching experience desired.
• Willingness to travel.

Note: This position is located in Montpelier, VT

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