The Business Systems Analyst acts as the primary interface between business stakeholders and IT teams to elicit and document functional and non-functional requirements. They are responsible for defining project scope, conducting systems analysis, and ensuring IT solutions align with business objectives.
Excellus BCBS
24 Remote Job Openings at Excellus BCBS
The Customer Care Advocate resolves member and provider inquiries regarding contract benefits, claim payments, and enrollment across multiple communication channels. They are responsible for documenting interactions and ensuring compliance with legislative requirements to enhance customer satisfaction.
The Actuarial Analyst performs services to support Health Plan operations, focusing on financial solvency, rate establishing, and reserve maintenance. Responsibilities range from basic data analysis and pricing for Level I to strategic planning and advanced statistical risk prediction for Level IV.
Utilization Management Reviewer (RN) - Multiple Positions!
Excellus BCBS
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Full Time
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11 days ago
Excellus BCBS
Responsible for coordinating and monitoring the utilization of behavioral and physical health services to ensure compliance with regulatory standards. Performs clinical reviews to determine medical necessity and collaborates with providers to ensure seamless care delivery.
Employee Relations Consultant I (Albany Region)
Excellus BCBS
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Full Time
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17 days ago
Excellus BCBS
Manage client-aligned relationships by resolving employee concerns, leading investigations, and ensuring compliance with workplace policies and external requirements. Oversee employee leave management programs and implement proactive employee relations strategies to maintain company culture and values.
The Business Systems Analyst collaborates with stakeholders to elicit and document functional and non-functional IT system requirements. They serve as the primary interface between business units and IT teams to ensure solutions align with organizational objectives.
Develop and optimize AI/ML solutions, including LLMs and generative AI, to solve business challenges and improve member health outcomes. Build scalable data pipelines and collaborate with cross-functional teams for model deployment and monitoring.
Print Operations Specialist I (Onsite - Overnight Shift)
Excellus BCBS
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Full Time
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22 days ago
Excellus BCBS
Operate production printers, finishing equipment, and high-speed mail insertion machinery to fulfill job requests. Maintain equipment, manage supplies, and ensure quality and accuracy of printed and mailed materials.
Conduct clinical investigations into potential fraud, waste, and abuse across various lines of business. This includes reviewing medical records, conducting audits, and collaborating with law enforcement and regulatory agencies to remediate FWA allegations.
The Software Engineer IV is responsible for designing, developing, and maintaining complex ETL processes and software system architectures. This role involves directing programming initiatives, mitigating technical risks, and serving as a subject matter expert for cross-functional teams.
Community Connections Representative I/II (Central New York Region)
Excellus BCBS
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Full Time
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22 days ago
Excellus BCBS
This role bridges the gap between health plan members and clinical operations through home visits and community outreach. Responsibilities include educating members on benefits, assisting with health insurance enrollment, and connecting individuals to community social services.
The role involves designing and creating correspondence and transactional statements using variable data composition systems. Responsibilities include developing code, resolving system issues, and maintaining document workflows and functional specifications.
Customer Care Advocate (Customer Care Representative)
Excellus BCBS
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Full Time
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22 days ago
Excellus BCBS
The Customer Care Advocate resolves customer inquiries regarding contract benefits, claim payments, and enrollment across multiple communication channels. They are responsible for enhancing member and provider satisfaction while adhering to legislative and corporate requirements.
Provides administrative and customer service support for Utilization Management workflows, including handling inbound and outbound calls and creating authorizations. Acts as a primary contact for providers and members while ensuring compliance with regulatory requirements and internal policies.
Design and maintain distributed public and private cloud platforms to provide flexible, secure, and resilient infrastructure services. Lead the deployment of PaaS, SaaS, and on-premises solutions while optimizing costs and ensuring alignment with business requirements.
Medical Director, Children's Behavioral Health
Excellus BCBS
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Full Time
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22 days ago
Excellus BCBS
Directs medical management, quality improvement, and credentialing functions for the children's behavioral health business unit. Provides medical leadership for utilization review, cost containment, and the implementation of performance improvement initiatives.
The consultant provides analytic support for pharmacy and medical drug information to drive strategy, growth, and affordability. They collaborate with multidisciplinary teams to deliver actionable insights and standardized reporting for senior management and external stakeholders.
Enrollment Specialist I/II/III/IV (Government Programs: CHP/QHP- Multiple Positions Available)
Excellus BCBS
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Full Time
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22 days ago
Excellus BCBS
Perform enrollment core processing and servicing for government programs and employer groups in accordance with HIPAA and health plan regulations. Manage inquiries from brokers, members, and administrators via phone, email, and in-person visits to ensure accurate eligibility and benefit updates.
Payment Integrity DRG Coding & Clinical Validation Analyst I/II/III (RHIA, RHIT, CCS, or CIC Certification Required)
Excellus BCBS
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Full Time
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22 days ago
Excellus BCBS
Review medical records to validate coding and DRG assignment accuracy, ensuring physician documentation supports hospital coded data. Perform audits of acute inpatient claims and provide guidance or leadership depending on the analyst level.
The IT Cloud Engineer Security III designs and implements security solutions for public and private cloud infrastructures to ensure trust and risk management. This role focuses on automation workflows, system analysis, and mentoring junior engineers to maintain a secure and resilient environment.
The Medical Director oversees utilization and case management activities, including clinical reviews and the development of medical policies. They serve as a liaison between the organization and the regional medical community while ensuring compliance with state and federal mandates.
Responsible for the accounting and financial reporting of company investments, including GAAP and statutory reporting and monthly close processes. Collaborates with internal finance teams and external custodians to ensure accuracy of financial data and regulatory compliance.
This role directs contracting activities for professional and ancillary healthcare services to ensure the corporation acts as a prudent purchaser. It involves developing reimbursement strategies, leading negotiations, and managing contractual disputes and templates.
Strategically manage vendor portfolios and relationships to ensure performance meets contractual obligations and business expectations. Lead sourcing, selection, negotiations, and governance activities while acting as a trusted advisor to business units.
