Your Role

The Network Compliance team is a key contributor to the company's success by working closely with various departments within Blue Shield and Blue Shield Promise, as well as with State regulators to ensure regulatory compliance requirements are met relative to provider networks. The Business Analyst, Consultant will report to the Senior Director, Network Compliance. In this role you will collaborate with various functional areas, such as Network Management and Contracting, Medical Care Solutions, Quality, Pharmacy, Sales, Product Development, Legal, Actuarial, Operations, and IT. In addition, we work closely with vendors and providers to develop, maintain, and expand various network configurations to meet our customers' needs throughout the state. The Provider Partnerships and Network Management Team is responsible for developing, maintaining, and managing Blue Shield's Commercial, State-Sponsored, and Medicare networks of professional and institutional healthcare professionals. This candidate for this position can be located anywhere in California.

Your Work

In this role, you will:

• Provide highly complex analytical support through the analysis and interpretation of data in support of cross-functional business operations
• Develop specialized files and employer reports for Block Transfer Filings relative to potential contract terminations with provider organizations and hospitals, ensuring company adherence to state filing requirements, and supporting Timely Access Compliance Reporting to the California Department of Managed Health Care and Annual Network Review submissions to the California Department of Insurance
• Develop, prepare, and analyze information with highly complex analysis and data for manager and regulatory reviews, and present to various levels of management
• Define business requirements and evolving business needs due to new laws/mandates and provide analyses to meet those increasing needs and produce operational efficiencies
• Provide analytical support for multiple, highly complex cross-functional projects simultaneously, establish work plans and timelines, coordinates with internal and external resources
• Prepare timely information Commercial clients as well as for plan partners, such as LA Care Health Plan, about network terminations affecting Medicaid managed care
• Assist other departments with compliance-related tasks, such as enrollee reassignments and other Block Transfer filing related needs related to a contract termination.
• Work independently under limited supervision
• Provide new perspectives and approaches for challenges and documents information

Your Knowledge and Experience

• Requires a bachelor's degree or equivalent experience
• Requires 7 years of prior relevant experience
• Strong analytical and problem-solving skills
• Ability to quickly learn company systems and access various databases to gather and compile information
• Practical knowledge of project management
• Technical writing ability

Pay Range:

The pay range for this role is: $96,470.00 to $144,760.00 for California.

Note:

Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.