Current Career Opportunities

Accountant Responsibilities

• Prepares monthly journal entries to record subscription income, claims, administrative expenses, and other financial activity for the Plan and its subsidiaries
• Prepares general ledger account reconciliations to ensure the accuracy and integrity of financial reporting
• Performs weekly balancing controls of the Plan’s claim payment runs to ensure accuracy and compliance
• Reviews Accounts Payable coding for consistency and accuracy; approximately 50+ Corporate Payable Vendor Accounts to monitor
• Reviews the Fixed Assets for accuracy of entry and that they meet capitalization guidelines for the company.  Prepares monthly journal entry to record depreciation. Performs monthly review of PWIP with managers throughout the Plan.  Performs a quarterly Tax Depreciation review to ensure all data has been entered in Fixed Asset Software correctly
• Performs all accounting for Federal Employee Program
• Performs detailed by Line Of Business (LOB) Claims expense reconciliation and analysis; works with Actuarial Services on major claims LOB variances
• Coordinates monthly meetings with Project Managers to assist them in the review of Corporate Project Monthly Financial Reports and the management of Project Capital and Operating Budgets  
• Files and accounts for various State Vaccine Program assessments.
• Assists with annual and ad hoc audit requests
• Actively participates and upholds the accuracy and integrity of Blue Cross VT financials

Accountant Qualifications

• BS degree in Accounting or Finance required
• Three to Five years of professional accounting experience required
• Experience in financial analysis required

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Clinical Case Manager Responsibilities:

• Perform the primary functions of case management–assessment, planning, facilitation, coordination, monitoring, evaluation, and advocacy–as appropriate in the health plan context to help members with high health complexity overcome biological, psychological, social and/or health system barriers to improvement and to achieve their desired clinical and functional outcomes.
• Conduct comprehensive assessments and develop personalized care plans in accordance with professional case management and accreditation standards, using evidence-based tools and applying relationship-building, motivational interviewing, risk-prioritization, and other related skills.
• Work collaboratively with members, families, and providers throughout the case management process, drawing upon knowledge of clinical, regulatory, and quality standards, health plan products and benefits, and community resources.
• Support members at all stages of their health care journey and across multiple settings and specialty areas, connecting with multiple providers and community-based organizations; guide members in accessing services to support their health and wellness goals in accordance with their benefits, partnering effectively with the Plan’s customer service, providers relations, and/or utilization management teams.
• Demonstrate a commitment to integrated, multi-disciplinary practice by proactively tapping into the expertise of the Plan’s clinical team of physicians, nurses, mental health clinicians, pharmacists, and colleagues in other departments who can help ensure the best possible experience and outcomes for the member.
• Participate in department and organization-wide initiatives to enhance member health and wellness, improve the quality of care, and generate cost-savings for our customers.

Clinical Case Manager Qualifications:

• Graduate of an approved program in professional nursing: RN, VT licensure required, BSN desired
• OR Licensed clinician in the State of Vermont with Master of Social Work degree (LICSW) or comparable degree and licensure in an allied mental health profession.
• 5 years of varied clinical practice experience required, preferably in a health care setting. Experience in the following clinical areas strongly desired: inpatient and post-discharge care, management of chronic conditions, including medical and mental health conditions, and substance use disorders.
• 1-3 years of case management or similar experience desired. CCM certification preferred and encouraged when eligible.

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Clinical Review Registered Nurse Responsibilities

• Execute utilization management processes to ensure the delivery of medically necessary and appropriate, cost-effective and high-quality care through the performance of clinical reviews. 
• Review requests against standardized medical necessity and appropriateness criteria for an initial and a continued service authorization.
• Identify questionable cases and refer to superior or a medical director for review. 

Qualifications

• RN with Vermont License required; BSN desired. 
• 5 – 7 years of clinical practice required.
• 1- 3 years of insurance related experience desired.
• Must be willing to participate in on-going CEU training.

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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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Responsibilities:

• Provide vision and problem-solving leadership on a company-wide level for infrastructure, cloud adoption and migration, desktop, and help desk. 
• Management focus on the implementation and usage of network and hardware infrastructure, telecom infrastructure, as well as computer operations strategy. 
• Anticipate future directions in the Information Technology industry, and then relate those changes to current and future infrastructure needs and projects of the organization.
• Safeguard and treat all data, information, and communications with uncompromising confidentiality and have knowledge of cyber security protocols and network security.

Qualifications:

• A minimum of 10 years of leadership in information strategy, architecture, technology, and programs. 
• Experience managing budgets ($10 M+), vendor relationships and business-planning.
• Bachelor’s degree in information technology, computer science, related field; equivalent relevant work experience.
• Master’s degree in information technology or a technology-related discipline preferred.
• Excellent verbal and communication skills.
• Excellent analytical and time-management skills.
• ITIL, Six Sigma, Project Management, Technical certifications would be a plus.
• Azure IAAS, PAAS Cloud Migrations
• Experience within the US healthcare industry is desirable.  

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Responsibilities

• Develop and produce reports and analyses in support of Affordable Care Act risk adjustment initiatives. 
• Work closely with IT in conjunction with the actuarial team to build out the Risk Adjustment Data Repository and become a Subject Matter Expert (SME) in healthcare data.
• Ensure the delivery of accurate data in support of the development of key risk adjustment performance metrics, interpretation of CMS risk score methodology, and risk score calculation.
• Develop algorithms needed to support risk adjustment models and support any process that involves the delivery and ingestion of risk adjustment vendors’ data, including the Edge Server submissions and RADV audit. 

Qualifications

• BA/BS in Actuarial Science, Mathematics, Statistics, Finance, Health Information Management, closely related field or equivalent experience required
• Minimum of 3 to 5 years of experience in actuarial science or data analysis, data integration, with 2 years in health industry or managed care
• Minimum of 3 to 5 years of SQL or SAS experience
• Experience in planning and supporting of data requirements is required
• Strong proficiency in Microsoft Office applications (Outlook, Word, Excel, PowerPoint)
• Knowledge of risk adjustment preferred

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Responsibilities:

• Ensure the company’s confidential information, assets, and intellectual property are safeguarded by complying with state and federal regulations, such as HIPAA, as well as corporate defined Information Security policies and standards.
• Lead the Managed Security Operation Center relationship and perform threat intel research and hunting at Blue Cross.
• Provide escalation support, such as defining and implementing policy changes to security control rulesets, troubleshooting security systems, and other related Engineering tasks.
• Serve as the designated incident response lead for the Blue Cross's security team and assist in further developing the company’s information security user awareness program.

Qualifications:

• A bachelor’s degree in computer science or equivalent information technology related field is required. Master of Science Preferred.
• 6+ years of experience in information assurance and security. Experience in the computer forensics field is preferred.
• Certified completion of a nationally recognized information systems security certification such as CISSP, CCSP, CRISC, certification(s) is required.

• Strong knowledge of the following areas desired: Security Information & Event Management (SIEM) technologies, eXtended Detection and Response (XDR), Data Loss Prevention (DLP), Web content filtering, Two-Factor Authentication, Intrusion Detection System (IDS) / Intrusion Prevention System (IPS), Advanced Persistent Threat (APT) systems, vulnerability management, firewall technologies, anti-virus and anti-malware technologies, computer forensics, threat intelligence, system access reviews, and log analysis.

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