Sr Payment Integrity Consultant - Payment Integrity

HCSC; Helena (MT); Hybrid; USD 70,000 - 126,000; Full time

Benefits offered by this job

Hybrid work model (3 days in office, 2

Flex/hybrid role

Job summary

Health Care Service Corporation (HCSC) is seeking a qualified professional to drive PI project implementations, report status and risks, and identify payment integrity opportunities. You will track KPIs and draft communications on progress, impact, and ROI, collaborating with cross-functional teams.

The role requires a Bachelor's degree with experience in health insurance operations, strong communication skills, and proficiency in MS Office.

Qualifications

• Bachelor's degree with 3+ years of business requirements experience or 7+ years in health insurance operations.
• Experience with payer operations and business requirements in a health insurance setting.
• Strong written and verbal communication skills and ability to work with cross-functional teams.

Responsibilities

• Drive implementation of PI-owned projects and report status and risks.
• Identify new payment integrity opportunities with cross-functional teams.
• Track KPIs and impact metrics and draft communications on project progress and ROI.

Skills

Payer operations knowledge

Implementation experience

Interpersonal communication

MS Office proficiency

Education

Bachelor's degree

Tools

Microsoft Office suite

Job description

Flex

IL - Chicago

MT - Helena

NM - Albuquerque

OK - Tulsa

TX - Richardson

R0056193

At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.

Join HCSC and be part of a purpose-driven company that will invest in your professional development.

Job Summary

This position is responsible for driving implementation of PI-owned projects, reporting status and risks. While working with cross-functional teams, responsible for identifying new payment integrity opportunities. Responsible for tracking and reporting KPIs and impact metrics, working with the PI Program Manager to draft communications on PI project progress, impact, value, and ROI.

Required Job Qualifications

• Bachelor's degree and 3 years of business requirement experience OR 7 years of business requirements experience in health insurance operational functions or relevant experience

• Knowledge of and experience in payer operations

• Implementation experience

• Clear and concise interpersonal, verbal and written communication skills

• PC proficiency with Microsoft applications including access, excel, word and power point

Preferred Job Qualifications

• Healthcare background

• Project Management experience

• Experience managing vendor contracts

• Advanced excel experience

This is a Flex (Hybrid) role: 3 days in office; 2 days remote.

Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!

Pay Transparency Statement

At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting https://careers.hcsc.com/totalrewards .

The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan.

Flex employees are expected to be in the office a minimum of three days a week. Management will have discretion to modify an employee's weekly schedule for exigent circumstances.

HCSC Employment Statement

We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics. We are a drug-free and smoke-free workplace. Employment may be contingent upon successful completion of drug screening in accordance with applicable law.

Base Pay Range

$69,800.00 - $125,900.00

Exact compensation may vary based on skills, experience, and location.

For more than 80 years, HCSC has been dedicated to expanding access to high-quality, cost-effective health care and equipping our members with information and tools to make the best health care decisions for themselves and their families. As an industry leader, HCSC also has been helping to make the health care system work better for all Americans. To remain a leader, we offer compelling careers that encourage resourcefulness, strategic thought and empower you to make a difference in the lives of our members and their communities.

Today, with the industry at an important crossroad, HCSC is reimagining health care and looking for original thinkers who aren’t afraid to make innovative contributions. We are an Equal Opportunity Employment employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Learn more about HCSC, our commitment to our members and the opportunity you’ll have to improve health care delivery in an open, collaborative environment.

HCSC is committed to diversity in the workplace and to providing equal opportunity to employees and applicants.

If you are an individual with a disability or a disabled veteran and need an accommodation or assistance in either using the Careers website or completing the application process, you can call us at 1-866-977-7378 to request reasonable accommodations.

Please note that only requests for accommodations in the application process will be returned. All applications, including resumes, must be submitted through HCSC's Career website on-line application process. If you have general questions regarding the status of an existing application, navigate to "candidate home" to view your job submissions.

Blue Cross and Blue Shield of Illinois, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of New Mexico, Blue Cross and Blue Shield of Oklahoma, and Blue Cross and Blue Shield of Texas,

Divisions of Health Care Service Corporation, a Mutual Legal Reserve Company, and Independent Licensee of the Blue Cross and Blue Shield Association

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