[Hiring] Sr. Government Ops Business Consultant @Capital Blue Cross

Role Description

The Senior Operations Consultant is responsible for providing analytical support to various business areas and customers. Also acts as subject matter expert providing technical and/or business knowledge to support decision making processes. Mentors business consultants and business analysts. Collaborates on the development of Medical Value initiatives and business intelligence platforms. Compliments Consultant responsibilities and initiative support by gathering and interpreting customer requirements, competitive information and industry standards.

• Participate in engagements with specific business areas and customers, such as:
  • External customers
  • Sales
  • Marketing
  • Quality Management
  • Network Management
  • Actuarial
  • Finance
  • Pharmacy Services
  • Care Management
  • Operations
• Responsible for the successful delivery of the design, development and implementation of analysis and research on the cost and utilization trends relative to product, program, network, benefit design, employer group, etc. and the communication of this information to key internal and external stakeholders.
• Ensures extensive research design, comprehensive data collection and sound statistical methods are applied to the cost and utilization forecasts, corporate reporting, programs, and corporate projects.
• Ensures appropriate development of research proposals, protocols, information needs, and data analysis plans to support the analysis and assessment of internal and vendor programs involving sales initiatives, contracting, quality improvement, clinical management, cost and utilization trend analysis and benchmarking, pharmacy benefit management, medical affairs, and other Corporate initiatives.
• Mentors business areas in the initial assessments, requirements, project plans, solutions, research and selections with a focus on data, information reporting, and analysis.
• Lead project task execution by ensuring progress, organizing project data, and coordinating team meetings.
• Focuses on project collaboration with business areas or external customers where a proficiency in business knowledge exists.
• Provides information to customers/clients in development of engagements, materials, events, initiatives, committees, meetings and presentations by gathering needed information and using appropriate frameworks and models in the development of assessment materials.
• Provides support for other analytical and reporting needs, trend analysis, financial improvement plans, compliance and regulatory reporting coordination (NCQA, HEDIS, DOH, HHS, CMS, FEP, OPM).
• Responsible for performing retrospective trend analysis, business requirement gathering, customer needs assessments, documentation of data needs/source mapping, competitive and industry information.

Qualifications

• Strong analytical and problem-solving skills.
• Experience in project management and collaboration.
• Proficiency in statistical methods and data analysis.
• Excellent communication and mentoring abilities.

Requirements

• Experience in a relevant field, such as operations, analytics, or consulting.
• Ability to work with various business areas and stakeholders.
• Knowledge of cost and utilization trends in healthcare.

Benefits

• Comprehensive benefits package including Medical, Dental & Vision coverage.
• Retirement Plan.
• Generous time off including Paid Time Off, Holidays, and Volunteer time off.
• Incentive Plan.
• Tuition Reimbursement.