Business consultant for projects involving significant or pervasive changes and participate in planning and architectural design of operational capabilities. Responsible for strategic support for technology related initiatives for a business segment. Consult on technical and data configuration solutions for minimal to no operational impact and support strategic initiatives/Roadmap via the Enterprise Capability Development Model. Partner with IT, the Architecture Application Group and key business areas to provide pre-project consultation and solution development. Support identification of business capabilities required to support strategic capabilities and identify preliminary capability critical path milestones or Go to Market (GTM) required for each 'segment'. Determine feasibility of capability implementation based on business operations and IT impacts (refine capabilities where needed). Serve as liaison between business units and IT. Document skills and technologies needed to deliver new capabilities. Support operational capability execution across the delivery lifecycle (e.g., UAT) to ensure implementation activities remain aligned to target design. Lead and develop team and oversee execution planning, business requirement gathering, system and data configuration, user acceptance testing, execution and post production support/ triage of issues across programs, projects and base activities. Utilize Operational Business Architect (OBA) framework to identify impacted business domains, extent of impact and complete an Impact Matrix - Domain View. Provide input to domain-based operating capability execution plans in terms of capabilities needed and milestones (GTM). Create / provide input to domain-based business blueprints (including people, process and technology needs) required to support business needs / strategies. Build cross-functional partnerships with Application Architecture Group, MDSS, Product Development, Corporate Planning, Enterprise Business Readiness, Health Care Value, Business Segments, NASCO Owner Plans Representatives, Operational Business areas and other corporate areas to ensure coordination and consistency in order to lead development of business blueprints (people, process and IT changes required) and work with Application Architecture Group (AAG) on impacts to architecture blueprints and solutions. Support build of initial business and IT delivery cost forecast. "Qualifications" * Bachelor's degree in computer science, information systems, computer engineering, systems analysis or a related discipline required. Master's degree preferred. * Ten (10) years' experience in related roles/ area of expertise. * Five (5) years' experience in a leadership role. * Extensive knowledge of current end-to-end business operations and application architecture blueprints (e.g., how multiple business domains interact, processes and tools to support a particular business outcome) * Extensive knowledge of system and application capabilities, interfaces and dependencies * Knowledge of Operational Business Architecture (OBA) framework and how new strategies and capabilities impact each domain. * Understand how dependencies between Products/Benefits, Enrollment, Rating, Membership and Billing, Claims Processing, Provider and Customer Service interrelate * Excellent analytical, organizational, verbal and written communication skills * Ability to identify, determine, influence and implement creative solutions to support strategic and operational initiatives and needs * Ability to translate capabilities to requirements to functionality that creates a positive user experience (from vision to implementation) * Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists * Ability to read and interpret a variety of instructions furnished in written, oral, diagram, or schedule form including process, procedure, and business manuals * Ability to develop strategy documents, decision papers, power point documents and correspondence Other related skills and/or abilities may be required to perform this job. Departmental Preferences * Five (5) years related work experience. Experience Details: All lines of business: Commercial PPO, HMO and Medicare product related work experience within a healthcare organization or equivalent combination of transferable experience and education is preferred. * Seven (7) years of Claim platform experience. Experience Details: Nasco-NPS, Facets and ika is preferred. * Demonstrated knowledge and application of Inter-Plan claims processing, payment integrity and overall policies/procedures is preferred. * Extensive working knowledge and demonstrated subject matter expertise in the areas of Federal, State and BCBSA regulatory mandates and compliance programs is preferred. * Ability to utilize functional and industry knowledge to efficiently and independently identify and build solutions for complex enterprise and product strategy issues related to Payment Integrity and Claims is preferred. * Strong problem-solving and analytical skills as well as strong business acumen of healthcare claims with an emphasis on Payment Integrity is preferred. All qualified applicants will receive consideration for employment without regard to, among other grounds, race, color, religion, sex, national origin, sexual orientation, age, gender identity, protected veteran status or status as an individual with a disability.
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