Principal Business Systems Consultant - Claims Operations

The Impact You Will Have

In this position you will act as a business systems consultant for business partners across the organization to plan, direct and manage business objectives and operational business systems readiness. You will facilitate meetings with business owners and subject matter experts on cross-functional teams to engage, develop and execute overall business and system rules and business initiatives. This position functions as the lead and business support for Product Management, Law Services, Sales, Marketing, Membership, IT, and across other divisions within Operations on various projects and work assignments by providing direction to stakeholders participating on corporate initiatives.

Your Responsibilities

• Leads the strategy and delivery for a product line and its business rules within all market segments.

• Develops the strategies and plans to implement and drive benefit business rules and goals.

• Collaborates with BCBSM management and IT in the early stages of project initiatives and definition to ensure consistent approaches in the business and technical design across projects or programs.

• Advances an integrated approach to identification and resolution of product changes and trends in collaboration with Sales, Product Management, the Contact Center and other functional areas.

• Drives the discovery and validation of business rules and product/benefit problems and opportunities.

• Directs and is responsible for successful delivery of new products, benefits and retiring products and data/parts to achieve business efficiency.

• Leads the planning and execution with the integrated business teams to ensure that product lines evolve and can be implemented in a seamless manner and compliant with State and Federal regulations.

• Provides data on benefits and products to Product Management to help sculpt/shape benefits and product design and/or business rules.

Required Skills and Experience

• 7+ years of related professional experience. All relevant experience including work, education, transferable skills, and military experience will be considered.

• 2 years experience of project management.

• Demonstrated organizational relationship management skills.

• Strong problem solving skills, conflict resolution, facilitation and negotiation skills.

• Excellent written and verbal communication skills.

• Self-motivated, ability to work independently, and demonstrated ability to work under tight time frames.

• Strong experience with the MS Office suite of products and SQL querying.

• Experience with Client Management suite of tools, Engineering Tools and/or Calligo suite of automation applications

• High school diploma (or equivalency) and legal authorization to work in the U.S.

Preferred Skills and Experience

• Bachelor's degree.

• Experience with Claims processing platforms

• Extensive experience using operational business systems.

• Experience with development of formal processes and methodologies.

• Proven ability to handle a variety of assignments at the same time.

• Previous knowledge of mapping benefit or non-benefit data.

Compensation and Benefits:

Pay Range: $102,400.00 - $138,300.00 - $174,200.00 Annual

Pay is based on several factors which vary based on position, including skills, ability, and knowledge the selected individual is bringing to the specific job.

We offer a comprehensive benefits package which may include:

• Medical, dental, and vision insurance
• Life insurance
• 401k
• Paid Time Off (PTO)
• Volunteer Paid Time Off (VPTO)
• And more

To discover more about what we have to offer, please review our benefits page.

Role Designation

Hybrid

Anchored in Connection

Our hybrid approach is designed to balance flexibility with meaningful in-person connection and collaboration. We come together in the office two days each week - most teams designate at least one anchor day to ensure team interaction. These in-person moments foster relationships, creativity, and alignment. The rest of the week you are empowered to work remote.