5 years of experience in analytical, actuarial or business analysis leadership role
7 years of experience working for a healthcare organization / health insurer
Preferred Education
Bachelor's Degree in Business, Healthcare, Mathematics, Economics, Finance or related field of study.
Preferred Licenses
N/A
Preferred Certifications
ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES
PRODUCT AFFORDABILITY (COST OF CARE MANAGEMENT)
Lead Segment specific cost of care efforts in identification, evaluation, implementation and monitoring of affordability and quality improvement initiatives designed to optimize the cost of high-quality medical care and achieve Segment specific Cost of Care savings targets.
Partner with Workstream leadership to identify and implement Affordability Initiatives impacting the Segment (Network, Clinical, Pharmacy, Value Based Care, Payment Integrity, Vendor Partnerships, etc.)
Partner with Analytics to identify, analyze, interpret, and validate trends and patterns in Segment utilization across provider panels, care settings and other categories, advising segment leadership team of affordability challenges and potential mitigating actions.
Develop business cases related to Segment cost of care initiatives to support Leadership decision-making and prioritization of opportunities based on balancing organizational alignment, ROI and resource constraints.
Provide leadership and segment representation on corporate committees, advocating for customer needs and effectively communicating decisions and actions to segment leadership.
Monitor external economic and healthcare issues affecting cost and utilization trends impacting the industry, the organization, and the segment.
SEGMENT NETWORK DEVELOPMENT
Prepare fact-based analysis and strategic recommendations to drive development of new/modified provider networks, including potential impacts of provider risk sharing as appropriate.
Partner with Analytics and Provider Network teams to identify providers and locations practicing high value care for inclusion in current or future Exclusive Network offerings.
Lead segment in Value-Based Partnerships, ens
Benefits
Health insuranceRemote work options
Additional Information
Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy. AZ Blue offers a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.
At AZ Blue, we have a hybrid workforce strategy, called Workability, that offers flexibility with how and where employees work. Our positions are classified as hybrid, onsite or remote. While the majority of our employees are hybrid, the following classifications drive our current minimum onsite requirements:
Hybrid People Leaders: must reside in AZ, required to be onsite at least twice per week
Hybrid Individual Contributors: must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per week
Hybrid 2 (Operational Roles such as but not limited to: Customer Service, Claims Processors, and Correspondence positions): must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per month
Onsite: daily onsite requirement based on the essential functions of the job
Remote: not held to onsite requirements, however, leadership can request presence onsite for business reasons including but not limited to staff meetings, one-on-ones, training, and team building
Please note that onsite requirements may change in the future, based on business need, and job responsibilities. Most employees should expect onsite requirements and at a minimum of once per week.
This position is hybrid within the state of AZ only. This hybrid work opportunity requires residency, and work to be performed, within the State of Arizona.
PURPOSE OF THE JOB
Lead Segment specific cost of care efforts in identification, evaluation, implementation and monitoring of affordability and quality improvement initiatives designed to optimize the cost of high-quality medical care and achieve Segment specific Cost of Care savings targets.
Manage Segment Affordability by partnering with Analytics to identify, analyze, interpret, and validate trends, advising Growth and Segment leadership team of affordability challenges and potential mitigating actions.
Partner with other Cost of Care Workstreams to identify and implement Affordability Initiatives (Network, Clinical, Pharmacy, Value Based Care, Payment Integrity, Vendor Partnerships, etc.)
REQUIRED QUALIFICATIONS
Required Work Experience
5 years of experience in analytical, actuarial or business analysis role
5 years of experience working for a healthcare organization / health insurer
Required Education
Bachelor's Degree in general field of study
Required Licenses
N/A
Required Certifications
N/A
Bcbsaz · AZ Blue Phoenix, AZ 85021