Current Career Opportunities
Current Openings
Responsibilities
- Evaluate incoming requests and determine proper distribution throughout the department and company.
- Analyze and research requests to determine BCBSVT, TVHP, FEP & NEHP member/benefit eligibility, including identifying OPL, waiting periods, benefit maximums, etc.
- Coordinate requests and create cases for prior approval and pre-certification in multiple systems (including: Customer Focus, Acuity, MHS, AS400) for review by clinical reviewers.
- Identify and refer members for case management based on diagnoses and types of service being requested.
- Enter and update authorizations to ensure appropriate claims processing based on clinical reviewers’ decision.
- Correspond with members and providers regarding decisions about requested services and to obtain medical records when necessary.
- Participate in on-going efforts to comply with NCQA, Rule 10 and URAC standards by performing quality assurance of outgoing correspondence, understanding time variations of requirements and responding to requests within the timeliness guidelines.
- Work collaboratively with other departments to obtain additional information to resolve claims, inquiry, and prior approval/pre-certification requests.
- Professionally and courteously answer, manage and appropriately route department telephone calls, processing calls regarding pre-certification and prior approval of services and referring to other departments when necessary.
- Review and respond to issues and questions from internal and external customers, both verbally and in writing.
- Act as a liaison between the Plan’s members, outside vendors and providers, and Blue Cross.
- Acquire and implement a high level of professional and service excellence when interacting with all customers, external as well as internal.
- Develop cooperative relationships both within and outside of the company.
- Provide clear, concise, and accurate interpretation of Plan certificate language, benefit administration, and all information communicated to customers.
- Manage electronic medical records and all incoming PHI, always maintaining the
highest level of confidentiality. - Assist clinical staff in gathering data, researching claims/authorizations, obtaining
medical records, and other duties as needed.
Qualifications
- High school diploma
- 1-3 years experience in the healthcare industry, preferably health insurance, is required.
- Experience in health insurance claims processing.
- Associate degree are preferred.
Responsibilities
- As a storyteller and skilled writer, balance “big picture” thinking with relevant, targeted messaging to reach and motivate target audiences.
- Plan, write, and edit long- and short-form content within required deadlines, carrying the brand voice through a variety of internal and external communications channels, both digital and print.
- Excel as a strong listener, interviewer, and investigator who translates complex business and healthcare information into meaningful and effective content.
- Work closely with organizational leaders and internal partners to develop, implement, and evaluate communications and project plans that support organizational priorities and goals.
- Ensure organizational priorities, initiatives, and updates are clearly communicated in a relevant, timely, and targeted manner.
- Establish evaluative criteria for monitoring the effectiveness of communications activities to help ensure desired results and the appropriate tracking methods.
- Plan and coordinate special projects, events, or other tasks as needed.
Qualifications
- Bachelor’s degree, preferably in communications, journalism, or public relations, or equivalent work experience.
- Minimum of 6+ years of professional writing or journalism experience, preferably with a communications or marketing team or agency. Healthcare industry experience a plus.
- Demonstrated experience writing for a variety of audiences.
- Prior management of complex projects and advising leadership.
- Proven ability to work with clients across all levels of the organization.
- Solid problem-solving and time-management abilities.
- Outstanding verbal and written communication skills.
- Excellent interpersonal and teamwork skills.
Responsibilities
- Provides oversight and direction to the Blue Cross VT pharmacy program, Vermont Blue Rx.
- Functions as the business owner of the overall commercial pharmacy program and provides consultative subject matter expertise for other business owners within the Company.
- Contribute to the overall corporate strategic activities and participate in client engagement activities.
- Responsible for oversight of Blue Cross and Blue Shield’s contracted PBM vendor for the purpose of ensuring contractual compliance, performance evaluation and accurate claims adjudication.
- Responsible for on-going maintenance of current pharmacy benefits and revising and implementing new benefits so that Blue Cross VT maintains a competitive pharmacy benefit offering to its customers.
- Establish best practices for pharmacy customer/member services through ongoing surveys and assessments of constituent satisfaction. Ensure the timely analysis of this information and implementation of appropriate improvements.
Qualifications
- Unrestricted license, either as a Registered Pharmacist (RPh) with advanced clinical pharmacy training, or a Pharm D with clinical residency, required.
- Minimum of ten years' pharmacy program experience partially performed within a health care domain.
- Demonstrated knowledge of Health Plan pharmacy benefit and policy, benefit cost analysis, and account management.
Responsibilities
- Complete a program comprised of classroom and on-the-job training that will provide the technical knowledge and customer service skills needed to accurately answer most member and provider questions.
- Learn and utilize customer service skills in order to successfully handle all customer interactions in a consistent, courteous, and professional manner.
- Accurately document, track, and research all inquiries in Customer Focus (CF) according to department guidelines and written procedures.
- Achieve a level of call volume and quality goals as set forth in the Customer Service Career Pathing Guidelines. Successful achievement of these goals will help enable to CSR to transition to a Customer Service Representative II position.
Qualifications
- High school graduate or equivalent required.
- Analytical and critical thinking skills required.
- Computer literacy, 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.
Responsibilities
- Responsible for a high level of quality by providing information and or initiating appropriate corrective actions to resolve a customer’s inquiry based on a thorough and comprehensive understanding of BCBSVT contracts, policies, systems and procedures.
- Maintain relationships between the Plan and its customers.
- Work with all levels of expertise including provider billing clerks to provider business managers, other BCBS plans as well as our subscribers and members.
- Work closely with other business units to address customer concerns and communicate feedback to our customers.
- Accurate and timely interpretations of the Plan policies and procedures while maintaining the absolute confidentiality of member and provider information.
Qualifications
- High school graduation or equivalent is required. Two year college degree is preferred.
- A minimum of 1-3 years customer service or claims processing experience in a healthcare or health insurance setting is required.
- Experience in a provider’s billing office is preferred.
Responsibilities
- Lead the development of print and digital marketing and communications materials, from concept through completion, and support the production of advertising campaigns.
- Employ “big picture” thinking and proven experience to support the strategic, tactical, creative, and operational facets of marketing, communications, and branding.
- Work regularly with internal subject matter experts, cross-departmental teams, and external vendors, such as designers, photographers, and videographers.
- Monitor and recommend ideas to improve the value, quality, and impact of marketing communications materials and the brand experience for our members, providers, and customers.
Qualifications
- Bachelor’s degree, preferably in marketing, business, or communications.
- Minimum of 5+ years of related experience in marketing communications, preferably for healthcare, health plan, or nonprofit organizations.
- Minimum of 5+ years of writing experience for marketing, advertising, communications, or corporate initiatives.
- Demonstrated experience in comprehensive project management and the creative development of print and digital materials.
- Strong understanding of art direction, print production, list coordination, direct mail processes, digital distribution, and reporting.
- Excellent written and oral communication skills, including and beyond copywriting, editing, and presenting.
- Excellent people skills, with thorough understanding and use of effective interpersonal communication skills.
- Experience with Microsoft Office is required, with preferred experience with Adobe programs.
Responsibilities
- Provide business and systems analytical subject matter expertise in support of Data Engineering initiatives.
- Detailed knowledge of business processes, business rules and a solid understanding of the systems that support such business functions at Blue Cross VT.
- Provide business subject matter expertise in the definition, testing, training, implementation, and support of business and functional requirements.
- Participate as an active member of project teams or work groups to provide business analysis and subject matter expertise for proposed solutions.
- Be an agile evangelist by fully participating on a scrum team focused on continuous improvement, collective growth, courage, innovation, and respond to change.
- Oversee the work of the Associate and Business Analysts
Qualifications
- BS/BA in Business or closely related field or equivalent experience required.
- 7+ years of experience in business analysis and system design and implementation required.
- Previous experience in health care or health insurance required.
- Prior experience working for a Blue Plan is preferred but not required.
- Experience planning and managing projects desired
- 7+ years of progressive experience working in an IT organization.
Blue Cross and Blue Shield of Vermont strictly prohibits discrimination against or by any Blue Cross and Blue Shield employee on the basis of race, color, religion, gender, age, national origin, place of birth, sexual orientation, gender identity, ancestry, disability, pregnancy, genetic information or marital status. Blue Cross and Blue Shield will not discriminate against an employee having a positive test result from an HIV related blood test, nor will Blue Cross and Blue Shield request or require an applicant or employee to have an HIV-related test as a condition of employment. Blue Cross and Blue Shield of Vermont will not discriminate against protected veterans.
Responsibilities
Qualifications
Experience utilizing analytics tools to measure, assess, and optimize digital strategies required.
Learn more and apply