Base pay is influenced by several factors including a candidate’s qualifications, relevant experience, and anticipated contributions to meet the needs of the business, along with internal pay equity and external market driven rates. The salary range displayed has not been adjusted for geographical location. This range has been created in good faith based on information known to Capital Blue Cross at the time of posting and may be modified in the future. Capital Blue Cross offers a comprehensive benefits packaging including Medical, Dental & Vision coverage, a Retirement Plan, generous time off including Paid Time Off, Holidays, and Volunteer time off, an Incentive Plan, Tuition Reimbursement, and more. 

At Capital Blue Cross, we promise to go the extra mile for our team and our community. This promise is at the heart of our culture, and it’s why our employees consistently vote us one of the “Best Places to Work in PA.”

Provide business consulting to proactively identify and manage technical business process improvement opportunities, specifically relating to HEDIS. Leveraging the work of business analysts, lead and participate in efforts to design innovative and strategic business processes that maximize Information Technology solutions, create sustainable competitive advantage and deliver administrative efficiencies. Provide project and program coordination to guide the implementation of new processes and process modification and assist with change management to minimize disruption and maximize impact. The Business Consultant understands requirements in the broadest context of business problems and opportunities and recommends solutions that enable innovative delivery of Capital’s products and service to our customers.

• Supports core functional application/tasks and demonstrates a thorough understanding of the technical aspects of the job. Includes understanding of end to end processes and downstream impacts. Provides well supported reasoning and documentation for technical recommendations and operational solutioning.
• Demonstrates effective project management and leadership skills to manage department and corporate projects with cross-functional team members. Includes communicating project team status updates verbally and in writing to any audience. Ability to identify potential projects risks and contingencies, conduct root cause analysis and identify process improvement opportunities.
• Ability to make complete technical and business re-engineering recommendations. Understands both the application configuration and process changes required to achieve greater efficiency or cost savings. Ability to communicate downstream impacts and full end to end processes related to subject matter.
• Demonstrates strong leadership skills. Ability and willingness to lead work teams and project teams in an exemplary, professional manner. Provides support and guidance to department staff at all levels on research and analysis assignments. Guide staff to the resources available to resolve and/or answer questions. Conduct training sessions and provide curriculum and materials as needed.
• Ability to communicate in all settings to various audiences. Communicates and messages in a thoughtful persuasive manner. Takes action to initiate multiple channels of communication in order to alert and inform staff and management. Ability to summarize verbally and in writing advanced analytical research to all audiences. Communicates delays, risks and/or impacts to upper management and business areas. Ability to effectively facilitate meetings and workshops and cross-functional teams and document outcomes. Represents the company at external conferences and workshops as a subject matter expert.
• Provides analysis to major projects and improvement efforts. Develops and manages project plans for projects. Guides project and program implementation efforts and manages change to assure expected results are achieved.
• Assures process documentation meets current and future requirements and supports the successful implementation of business innovation.
• Provides assistance to less experienced analysts and consultants on a broad range of project management and process engineering disciplines to disseminate learning and promote the development of others.
• Other Duties as assigned

Skills:

• Experience and proficient knowledge of project management techniques. Includes experience in planning, organizing, leading and managing multiple projects concurrently.
• Demonstrated experience in leading cross functional teams and facilitate successful outcomes.
• Demonstrated ability to create requirements document and test plans
• Proficient at MSOffice (Word, Excel, Outlook)
• Demonstrated capability to communicate effectively with all levels of internal/external personnel to prepare written materials and oral presentations for technical and non-technical audiences. Includes seasoned negotiation/persuasion skills to lead meetings and ensure mutually agreeable solutions among multiple departments/Plans, as well as successful completion of a project.
• Advanced problem-solving and structured analysis/design techniques. Includes the ability to understand complex inter-related systems and to independently resolve business and technical problems encountered.
• Ability to adapt to constantly changing priorities. Includes ability to work with minimal supervision and to inspire teamwork among diverse groups.
• Ability to effectively leverage resources to create exceptional outcomes, embraces change, and constructively resolves barriers and role essentials.

Knowledge:

• Preferred knowledge of the health care industry. Includes knowledge of standards, policies, and familiarity with business practices and procedures for multiple departments/systems, especially those related to claims administration, information services, provider networks, clinical, account administration, marketing, rating, underwriting, actuarial, customer service and corporate performance. Also includes an understanding of the corresponding business practices and interrelationships with other Plans.
• Knowledge of data processing terminology and concepts. Includes knowledge of batch/real-time processing environments, sequential versus random processing and remote teleprocessing concepts and web-based technologies (Internet/Intranet).
• Comprehensive knowledge of all Microsoft Office applications, including Word, Excel, Access and Power Point.
• Knowledge of SaaS, SQL, and Informatica highly preferred.

Experience:

• 5 years technical or operational work experience.
• Preferred Project management experience.

Education and Certifications:

• High School diploma or equivalent.
• Preferred Bachelor’s Degree in Business Administration, Health Planning and Administration, Information Systems, Computer Science or a related field. Continued higher education is strongly recommended.

Work Environment:

• Working environment includes typical office conditions.

Physical Demands:

• While performing the duties of the job, the employee is frequently required to sit, use hands and fingers, talk, hear, and see. The employee must be able to work over 40 hours per week. The employee must occasionally lift and/or move up to 5 pounds. Sedentary work involving significant periods of sitting, talking, hearing, keying and performing repetitive motions. Work requires visual acuity to perform close inspection of written and computer-generated documents as well as a PC monitor. Working environment includes typical office conditions.

 

We recognize that work is a part of life, not separate from it, and foster a flexible environment where your health and wellbeing are prioritized. At Capital you will work alongside a caring team of supportive colleagues, and be encouraged to volunteer in your community.  We value your professional and personal growth by investing heavily in training and continuing education, so you have the tools to do your best as you develop your career.    
And by doing your best, you’ll help us live our mission of improving the health and well-being of our members and the communities in which they live.