Job DescriptionYour RoleThe Payment Integrity team is responsible for ensuring healthcare claims are paid accurately, both in a pre-pay and post-pay context. Some examples of payment integrity include validating coding rules, determining the correct party, membership eligibility, contractual adherence, and conducting root cause analysis to prevent errors. This team is responsible for over $400M+ of cost of healthcare savings and avoidance annually and is also responsible for developing new capabilities to improve cost of healthcare exposure and performance, managing multiple third-party partners in pursuit and prevention of over-payments. The Business Analyst Consultant of Payment Integrity will report to the Director of Payment Integrity. In this role you will collaborate with various internal teams and vendors to improve cost of healthcare and premium cost outcomes.ResponsibilitiesYour WorkIn this role, you will: Provide highly complex analytical support through the analysis and interpretation of data in support of cross-functional business operations Lead the development of annual operating plans, capital budgets and forecasts, and build business cases for new business initiatives (cost/benefit analysis) Develop, prepare, and analyze reports with highly complex analysis and data for management review, and presents to various levels of management Define business requirements and provide analysis to increase operational efficiency Provide analytical support for multiple, highly complex cross-functional projects simultaneously, establish work plans and timelines, coordinates with internal and external resources Lead the evaluation, design, development, and implementation of new products that will improve Blue Shield's payment integrity performance Identify novel avenues of pursuit for the improvement of payment accuracy Work with internal teams and external vendors on complex initiatives aimed at achieving cost savings and increased effectiveness Validate payment integrity concepts through interpretation of provider contracts, review of regulatory guidelines, and system configuration Identify root cause of issues through data analysis and collaborate with other teams to reduce payment errors Participate in issue resolution by providing analytic support and collaborating with various internal stakeholdersQualificationsYour Knowledge and Experience Requires a bachelor's degree or equivalent experience Requires at least 7 years of prior relevant experience In depth experience with payment integrity practices and related operations preferred Possess strong data/analytic, financial, and process experience Familiarity with medical claim coding standards and concepts SQL expertise desired FACETS claim processing system experience desiredAbout the TeamAbout Blue Shield of CaliforniaAs of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies. At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience. To achieve our mission, we foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals.Blue Shield is a U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company and a Top 100 Inspiring Workplace. We were recognized by Fair360 as a Top Regional Company, and one of the 50 most community-minded companies in the United States by Points of Light. Here at Blue Shield, we strive to make a positive change across our industry and communities - join us! Our Values: Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short. Human. We strive to listen and communicate effectively, showing empathy by understanding others' perspectives. Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.Our Workplace Model:At Blue Shield of California and the Ascendiun Family of Companies, we believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility. As we continue to evolve our workplace model, our focus remains on creating spaces where our people can connect with purpose - whether working in the office or through a hybrid approach - by providing clear expectations while respecting the diverse needs of our workforce.Two Ways of Working: Hybrid (Default): Work from a business unit-approved office at least two (2) times per month (for roles below Director-level) or once per week (for Director-level roles and above).Exceptions:o Member-facing and approved out-of-state roles remain remote.o Employees living more than 50 miles from their assigned offices are expected to work with their managers on a plan for periodic office visits.o For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being. On-Site: Work from a business unit-approved office an average of four (4) or more days a week.Physical Requirements:Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.Please click here for further physical requirement detail. Equal Employment Opportunity:External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.

Job DescriptionYour RoleThe Installation and Billing Operational Governance team supports business analysis for operational enrollment, operational output and interfaces. The Business Analyst will report to the Program and Project manager. In this role you will support operational enrollment teams through data interpretations, data analysis, process improvement, incident resolution and project support. This role will also support internal Service enhancements and user develop testing for IT changes and work in the agile framework to deliver continuous improvements to their area of focus.ResponsibilitiesYour WorkIn this role, you will: Provide analytical support through the analysis and interpretation of data in support of cross-functional business operations Contribute to annual operating plans, capital budgets and forecasts, and build business cases for new business initiatives (cost/benefit analysis) Develop, prepare and analyze reports for management review, and present to various levels of management Define business requirements and provide analysis to increase operational efficiency Analyze actual results against plan and forecast and recommend interventions where appropriate Analyze data from various sources to determine root cause analysis on operational issues and project defects Understanding and management of overall end to end process of assigned area; ensuring risks, issues and process are documented thoroughly and communicated out effectively. Responsible for process improvements, system updates or product deployments to enhance operational performance in relation to our Agile methodology. Managing stakeholder engagement and expectations, building effective working relationships with both Business and Information Technology stakeholders Other Duties as assignedQualificationsYour Knowledge and Experience Requires a bachelor's degree or equivalent experience Requires at least 3 years of prior relevant experience Experience with Enrollment processes with member enrollment heavily preferred. Experience with Facets and EDI files preferred Networking, buisness collaboration and analytical skills desired Proficient in MS office suite (Excel, PowerPoint, Word) Excellent verbal and written communication skillsAbout the TeamAbout Blue Shield of CaliforniaAs of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies. At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience. To achieve our mission, we foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals.Blue Shield is a U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company and a Top 100 Inspiring Workplace. We were recognized by Fair360 as a Top Regional Company, and one of the 50 most community-minded companies in the United States by Points of Light. Here at Blue Shield, we strive to make a positive change across our industry and communities - join us! Our Values: Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short. Human. We strive to listen and communicate effectively, showing empathy by understanding others' perspectives. Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.Our Workplace Model:At Blue Shield of California and the Ascendiun Family of Companies, we believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility. As we continue to evolve our workplace model, our focus remains on creating spaces where our people can connect with purpose - whether working in the office or through a hybrid approach - by providing clear expectations while respecting the diverse needs of our workforce.Two Ways of Working: Hybrid (Default): Work from a business unit-approved office at least two (2) times per month (for roles below Director-level) or once per week (for Director-level roles and above).Exceptions:o Member-facing and approved out-of-state roles remain remote.o Employees living more than 50 miles from their assigned offices are expected to work with their managers on a plan for periodic office visits.o For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being. On-Site: Work from a business unit-approved office an average of four (4) or more days a week.Physical Requirements:Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.Please click here for further physical requirement detail. Equal Employment Opportunity:External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.

Job Description Your Role The Installation and Billing Operational Governance team supports business analysis for operational enrollment, operational output and interfaces. The Business Analyst will report to the Program and Project manager. In this role you will support operational enrollment teams through data interpretations, data analysis, process improvement, incident resolution and project support. This role will also support internal Service enhancements and user develop testing for IT changes and work in the agile framework to deliver continuous improvements to their area of focus. Responsibilities Your Work In this role, you will: <ul> <li>Provide analytical support through the analysis and interpretation of data in support of cross-functional business operations</li> <li>Contribute to annual operating plans, capital budgets and forecasts, and build business cases for new business initiatives (cost/benefit analysis)</li> <li>Develop, prepare and analyze reports for management review, and present to various levels of management</li> <li>Define business requirements and provide analysis to increase operational efficiency</li> <li>Analyze actual results against plan and forecast and recommend interventions where appropriate</li> <li>Analyze data from various sources to determine root cause analysis on operational issues and project defects</li> <li>Understanding and management of overall end to end process of assigned area; ensuring risks, issues and process are documented thoroughly and communicated out effectively. </li> <li>Responsible for process improvements, system updates or product deployments to enhance operational performance in relation to our Agile methodology. </li> <li>Managing stakeholder engagement and expectations, building effective working relationships with both Business and Information Technology stakeholders</li> <li>Other Duties as assigned</li></ul> Qualifications Your Knowledge and Experience <ul> <li>Requires a bachelor's degree or equivalent experience</li> <li>Requires at least 3 years of prior relevant experience</li> <li>Experience with Enrollment processes with member enrollment heavily preferred. </li> <li>Experience with Facets and EDI files preferred</li> <li>Networking, buisness collaboration and analytical skills desired </li> <li>Proficient in MS office suite (Excel, PowerPoint, Word)</li> <li>Excellent verbal and written communication skills</li></ul> About the Team About Blue Shield of California As of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies. At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience. To achieve our mission, we foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals. Blue Shield is a U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company and a Top 100 Inspiring Workplace. We were recognized by Fair360 as a Top Regional Company, and one of the 50 most community-minded companies in the United States by Points of Light. Here at Blue Shield, we strive to make a positive change across our industry and communities - join us! Our Values: <ul> <li>Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.</li> <li>Human. We strive to listen and communicate effectively, showing empathy by understanding others' perspectives.</li> <li>Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.</li></ul> Our Workplace Model: At Blue Shield of California and the Ascendiun Family of Companies, we believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility. As we continue to evolve our workplace model, our focus remains on creating spaces where our people can connect with purpose - whether working in the office or through a hybrid approach - by providing clear expectations while respecting the diverse needs of our workforce. Two Ways of Working: <ul> <li>Hybrid (Default): Work from a business unit-approved office at least two (2) times per month (for roles below Director-level) or once per week (for Director-level roles and above).Exceptions:</li></ul> o Member-facing and approved out-of-state roles remain remote. o Employees living more than 50 miles from their assigned offices are expected to work with their managers on a plan for periodic office visits. o For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being. <ul> <li>On-Site: Work from a business unit-approved office an average of four (4) or more days a week.</li></ul> Physical Requirements: Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day. Please click here for further physical requirement detail. Equal Employment Opportunity: External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.

Job Description Your Role The Operational Integrity team plays a key role in ensuring operational areas are always compliant and audit ready. The Business Analyst, Principal will report to the Director, Operational Integrity. In this role you will track internal and external audit and risk management activities across operational functions, ensuring compliance, risk reduction and improved audit performance. Work involves partnering with cross-functional key stakeholders to identify high-risk processes, high risk audit areas and the design, implementation, and continuous monitoring of appropriate internal controls to mitigate risk. Responsibilities Your Work In this role, you will: <ul> <li>Establish and cultivate relationships across key business execution roles</li> <li>Proactively anticipate organizational needs based on customer and industry trends </li> <li>Lead the planning, execution, and reporting of overall operational audit readiness, status and risk management; ensuring alignment with regulatory requirements and industry best practices.</li> <li>Participate in enterprise risk planning activities (i.e. business resiliency planning) and drive standardization and compliance across all operational areas.</li> <li>Ensure compliance and risk mitigation action planning to meet relevant association and regulatory requirements</li> <li>Lead or participate in root cause discovery processes and development and implementation of corrective action plans</li> <li>Serve as a key operational liaison with Internal Audit, Compliance Teams and Internal Controls team to ensure continuous maturation of internal controls across operational areas</li> <li>Collaborate with process owners to identify high risk areas and ensure control deficiencies are remediated timely and effectively</li> <li>Communicate complex concepts and findings clearly to senior leadership and stakeholders</li> <li>Other responsibilities as assigned</li></ul> Qualifications Your Knowledge and Experience <ul> <li>Requires a bachelor's degree or equivalent</li> <li>Requires at least 10 years of prior relevant experience</li> <li>Experience in healthcare industry is preferred</li> <li>Strong understanding of internal controls and practical application in operational processes</li> <li>Strong understanding of audit and corrective action planning process</li> <li>Knowledge of industry programs, policies, procedures, regulations, and laws.</li> <li>Considerable skill in planning and project management, and in maintaining composure under pressure while meeting multiple deadlines</li> <li>Excellent communication skills. Communicate results written reports and oral presentations to mid-level and senior leadership</li> <li>Team player with strong interpersonal, communication, and project management skills</li></ul> About the Team About Blue Shield of California As of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies. At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience. To achieve our mission, we foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals. Blue Shield is a U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company and a Top 100 Inspiring Workplace. We were recognized by Fair360 as a Top Regional Company, and one of the 50 most community-minded companies in the United States by Points of Light. Here at Blue Shield, we strive to make a positive change across our industry and communities - join us! Our Values: <ul> <li>Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.</li> <li>Human. We strive to listen and communicate effectively, showing empathy by understanding others' perspectives.</li> <li>Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.</li></ul> Our Workplace Model: At Blue Shield of California and the Ascendiun Family of Companies, we believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility. As we continue to evolve our workplace model, our focus remains on creating spaces where our people can connect with purpose - whether working in the office or through a hybrid approach - by providing clear expectations while respecting the diverse needs of our workforce. Two Ways of Working: <ul> <li>Hybrid (Default): Work from a business unit-approved office at least two (2) times per month (for roles below Director-level) or once per week (for Director-level roles and above).Exceptions:</li></ul> o Member-facing and approved out-of-state roles remain remote. o Employees living more than 50 miles from their assigned offices are expected to work with their managers on a plan for periodic office visits. o For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being. <ul> <li>On-Site: Work from a business unit-approved office an average of four (4) or more days a week.</li></ul> Physical Requirements: Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day. Please click here for further physical requirement detail. Equal Employment Opportunity: External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.

Your Role
The Operational Integrity team plays a key role in ensuring operational areas are always compliant and audit ready. The Business Analyst, Principal will report to the Director, Operational Integrity. In this role you will track internal and external audit and risk management activities across operational functions, ensuring compliance, risk reduction and improved audit performance. Work involves partnering with cross-functional key stakeholders to identify high-risk processes, high risk audit areas and the design, implementation, and continuous monitoring of appropriate internal controls to mitigate risk.
Your Work
In this role, you will:

Establish and cultivate relationships across key business execution roles
Proactively anticipate organizational needs based on customer and industry trends
Lead the planning, execution, and reporting of overall operational audit readiness, status and risk management; ensuring alignment with regulatory requirements and industry best practices.
Participate in enterprise risk planning activities (i.e. business resiliency planning) and drive standardization and compliance across all operational areas.
Ensure compliance and risk mitigation action planning to meet relevant association and regulatory requirements
Lead or participate in root cause discovery processes and development and implementation of corrective action plans
Serve as a key operational liaison with Internal Audit, Compliance Teams and Internal Controls team to ensure continuous maturation of internal controls across operational areas
Collaborate with process owners to identify high risk areas and ensure control deficiencies are remediated timely and effectively
Communicate complex concepts and findings clearly to senior leadership and stakeholders
Other responsibilities as assigned

Your Knowledge and Experience

Requires a bachelor's degree or equivalent
Requires at least 10 years of prior relevant experience
Experience in healthcare industry is preferred
Strong understanding of internal controlsand practical application in operational processes
Strong understanding of audit and corrective action planning process
Knowledge of industry programs, policies, procedures, regulations, and laws.
Considerable skill in planning and project management, and in maintaining composure under pressure while meeting multiple deadlines
Excellent communication skills. Communicate results written reports and oral presentations to mid-level and senior leadership
Team player with strong interpersonal, communication, and project management skills

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Business Analyst Blue Shield Of California Jobs

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Business Analyst ConsultantApril 12, 2025

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