Manager, System Support Services at Blue Cross and Blue Shield of North Carolina in Durham, North Carolina

Job Description:

The majority of our roles will be work from home until the end of June 2021. We are evaluating when it is safe to begin working in the office again. Please talk with your Talent Advisor during the interview process for more information.

Additional Locations:

Out of State Teleworker (Michigan)

Job Description

Provider Data Management at Blue Cross NC is going through an exciting transformation that involves our people, our processes and our technologies. As we prioritize around key initiatives, we are looking for a Manager to join our growing team.

You will bring experience with provider data lifecycle management as well as leadership skills for leading program and quality initiatives. You will be responsible to coach team members in the use of appropriate analytical tools and data mining that supports improved quality. You will lead reporting efforts of data quality reporting and have intimate knowledge of CAQH programs that leverage enhancement in credentialing operations and improvements in provider data quality. You will be responsible for departmental staffing decisions and support team members in the identification and creative problem resolution for improved processes and expanded use of technology. You will also support collaborative team efforts that produce effective working relationships, build trust and participate and contribute to ongoing governance initiatives and protocol.

About Commercial & Government Service Operations (CGSO) at Blue Cross NC

Core Production is a key team within CGSO. Comprised of about 1,000 employees across five business areas, we ensure an exceptional experience for our members through timely and accurate enrollment, billing, claims, and provider processing. Within Configuration and Provider Data Management we configure products and maintain accurate provider data.

What You'll Do

• Oversee all activities related to the management and maintenance of provider data, including continuous quality improvement and accuracy of processes to ensure high quality provider data




• Develop and produce management and operational reports and fulfill other ad hoc reporting needs including reports for State




• Responsibility for hiring, training, assigning work, and performance management of direct report staff and includes coaching, conflict resolution and motivating and engaging. Manage growth and development of personnel, with career development, performance management and succession planning.




• Provides direction to provider teams responsible for audit program, compliance and provider facing initiatives. This includes support of subject matter experts, business analysts, and/or application administrators supporting business initiatives and system enhancements to ensure




• Directs staff in conducting high level business analysis involving complex requirements, problem resolution, and/or processes for business area systems.




• Ensures planning and staffing of resources are adequately aligned to address business initiatives; recommends improvements; provides business process knowledge and/or subject matter expertise for addressing business area technology decisions.




• Ensures efficiency and productivity of systems used by being an integral part of design and problem-solving teams where Information Systems (IS) is engaged.




• Responsible for the development of best practices for support processes and procedures including tools and techniques to optimize performance.




• Networks and collaborates effectively with user workgroups and cross functional system area support teams that include multiple Information Systems teams and/or Vendors to effectively manage optimization.




• Ensures validation of IS and/or vendor provided technical solutions and/or identifies alternatives to solve business problems.




• Seeks opportunities to enhance systems, services, and products.

What You Bring (Hiring Requirements)

• Bachelor's degree




• 5 years management/leadership experience to include business analysis and Provider Data Domain technical and functional knowledge.




• If no bachelor's degree 7 years management/leadership experience to include business analysis and Provider Data Domain technical and functional knowledge.




• Demonstrated knowledge of industry solutions including CAQH products and services and experience with payer provider systems and lifecycle management.

Nice to Have

• Degree in Business Administration with computer coursework or Computer Science preferred.




• Project management experience and development methodologies experience that supports both the business and technical needs of the business.




• Business impact analysis experience demonstrated in work experience, such as providing ROI, business case documentation, or formal proposals.




• Excellent influencing and consultative skills; and the ability to proactively identify and resolve issues and opportunities.




• The ability to determine the information necessary to strategically assess market situations as well as the ability to evaluate and determine optimal plans of action is essential.

If you're ready to make a career out of making a difference, this is the opportunity for you.

Apply Now