Provider Services Operations Specialists

At Blue Cross and Blue Shield of Nebraska, we are a mission-driven organization dedicated to championing the health and well-being of our members and the communities we serve.

Our team is the power behind that promise. And, as the industry rapidly evolves and we seek ways to optimize business processes and customer experiences, there’s no greater time for forward-thinking professionals like you to join us in delivering on it! As a member of Team Blue, you’ll find purpose, opportunities and the support you need to build a meaningful career and make a powerful impact in our community.

This position provides support for Provider Services strategic initiatives to optimize business processes. The role is accountable to provide guidance and to communicate the technical and business changes with internal and external customers. The individual will provide analysis and direction, where subject matter expertise is required. The role will require an individual to have strong influence skills, be a strong communicator and be able to think out of the box for ways to see result.

The ideal candidate will live within driving distance of the Omaha, Nebraska office or state of Nebraska. If local, this position allows remote flexibility but will have 1 day per week in the office.  

If living in one of our approved states (Florida, Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, and Texas)  – this person may travel to our headquarters.

What you'll do:

• Represent Provider Services in organization changes that have potential impact to the department.
• Researches, coordinates, manages, and implements Provider Services projects.
• Operates as a Subject Matter Expert (SME) with extensive business and technical knowledge on the feasibility and implementation of system and process changes.
• Engages the appropriate individuals, teams and/or groups regarding technology/platform changes that affect the business.
• Provides final approval for requirements, functional specs and user acceptance test scenarios.
• Participates on internal and external cross-function work groups and provides guidance and shared knowledge on technical and interpersonal escalated issues.
• Provides accurate provider data analytics to the assigned administration team and collaborative partnerships as appropriate.
• Works on association releases, complex special projects, federal mandates, and network implementations.
• Understand downstream impact of provider data and monitor the flow of data to external vendors by coordinating with I/S teams and vendor relations contacts.
• Coordinates and completes other tasks and projects as assigned by management.
• Responsible for keeping provider data for multiple systems in sync for the enterprise. Includes data reconciliation efforts and system adjustment activities.
• Update system data that is identified as needing changes in analysis. Collaborate with training team on new process needs.

To be considered for this position, you must have:

• Bachelor’s degree in business, information technology or related field and five (5) years of experience in a data analysis or technical business-related role in the health care industry.
• Intermediate knowledge in SQL.
• 3+ years’ experience in implementing data controls.
• Demonstrated experience in performing issue research and resolution.
• Strong knowledge of business development, strategic planning, support and process improvement.

The strongest candidates for this position will also possess:

• Experience in AGILE methodology.
• Claims and/or provider relations experience.

Learn more about what makes BCBSNE such an exceptional place to work by visiting NebraskaBlue.com/Careers.

We strongly believe that diversity of experience, perspective and background will lead to a better workplace for our employees and a better product for our customers and members.