CareFirst BlueCross BlueShield
Owings Mills, MD, United States
Resp & Qualifications
As a member of the Federal and Consumer Government Programs (FSCGP) leadership team, the position of Director, Data Analytics & Program Performance supports all aspects of the Medicare (including Advantage) and Medicaid programs’ research and data analytics efforts. Leads a diverse team of data analytics professionals, overseeing the business and technical portions for all operational areas. Embeds deep analytical insights into key decision processes, through constant focus on a variety of complex business problems and assuring adherence to all regulatory reporting requirements. Leads all aspects of the Medicare & Medicaid Program’s research and data analytics efforts, including development of solutions with moderate complexity and risk with business area implications. Oversees the tracking, development, submission and monitoring of data for all regulatory reporting needs of the FSCGP division.
Leads and/or participates in complex cross-functional project teams representing the FSCGP division. Collaborates with business partners to understand their strategy, problems and goals; translating business problems into analytical solutions. Supports data efforts utilized by business to drive strategy and planning efforts. Supports deployment of insights across multiple channels (operations, compliance, strategy). Oversees strategic planning and development of informatics solutions in partnership with technical and business leadership. Responsible for program performance for Medicare (CMS) and Medicaid (state).
Drives the development, consolidation and validation of all data analysis and reporting, including complex reports and analyses using multiple data sources, including custom SQL queries. Creates and oversees processes to receive, document, prioritize and assigns new requests for reports, tracks progress on both ad hoc and recurring reports and communicate with internal customers in a manner that ensures high customer satisfaction. Identifies and executes strategies to improve the efficiency and effectiveness of the Data Analytics team. Leads timely and accurate monthly and annual reporting, as required.
Consults with FSCGP Leadership and Medicare Advantage & Medicaid cross-functional divisions to ensure organizational quantitative and qualitative research needs are met and all data collection and analytics efforts are streamlined and optimized. Facilitates the development of key performance indicators utilizing advanced statistical analyses and methodologies and translates findings into actions. Identifies process improvements during the measurements process and collaborates with FSCGP leadership to resolve. Directs the coordination and delivery of key analyses to FSCGP leadership and generates critical actionable insights as to improvements in operation efficiencies, program performance and meetings the changing needs of business.
Directs development, monitoring and submission to federal and state entities of internal and external reports for all regulatory needs. Maintains current knowledge of applicable federal and state laws including developments in Medicare, Medicaid, Medicare Advantage, CMS and of legislative and regulatory implications. Collaborates with Compliance and Legal to assure all regulatory requirements related to reporting are met. Maintains internal control safeguards and coordinates applicable audit activities.
Collaborates with IT to develop and support enterprise-wide strategies, processes, and standards for business intelligence, data discovery and reporting; communicate standards to drive consistency and integration of organizational data-driven initiatives. Works closely with vendors and FSCGP technical teams to ensure data reporting, file imports and exports from data warehouse and production applications are achieved in a timely manner.
Lead, challenge and motivate a staff to obtain their full potential. Provide direction and prioritization support in order to manage allocation of resources to meet work fluctuations. Review staffing goals and expectations to ensure that each is consistent and adequate to meet department goals. Accountable to drive the performance assessment of all direct reports, generate development plans and set goals within the context of the corporate policy. Provide coaching, counseling and motivation to team members ensuring staff has the appropriate tools and training.
Manages a staff of 4 non-management reports, including Reporting and Business Analysts.
Bachelor’s degree in health care field, math, statistics, or other quantitative area, or equivalent experience; at least 7-10 years business experience with analytics and reporting, healthcare data experience preferred; inclusive of 5 years managerial experience.
Must have proven problem-solving, critical thinking and analytical skills.
Proficiency in data management concepts, database structure and business intelligence platforms.
Experience in data analytics for health insurance or managed care and/or government programs.
Demonstrates strong ability to communicate technical concepts and implications to business partners.
Ability to anticipate and prevent problems before they occur.
Master’s degree in quantitative field or MBA.
Experience in applicable federal and state reporting and/or regulatory compliance.
Experience in data analytics for Medicare Advantage and/or Medicaid.
: The incumbent should have strong customer service orientation, excellent oral and written communication skills, the ability to synthesize information quickly and the ability to motivate and persuade others. Incumbent should possess strong interpersonal skills and should be able to deal effectively with individuals and task forces at all levels of the organization. The incumbent must possess extremely well developed organizational and prioritization skills as well as strong process orientation skills.
Must be able to effectively work in a fast-paced environment with frequently changing priorities, deadlines, and workloads that can be variable for long periods of time. Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.
Department: Federal & State Consumer Government Programs
Equal Employment Opportunity
CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.
Hire Range Disclaimer
Actual salary will be based on relevant job experience and work history.
Where To Apply
Please visit our website to apply: www.carefirst.com/careers
Please apply before: 09/11/2019
Federal Disc/Physical Demand
: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.
The physical demands described here are representative of those that must be met by an associate to perform the essential duties and responsibilities of the position successfully. Requirements may be modified to accommodate individuals with disabilities.
The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands may regularly be used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights of up to 25 pounds are occasionally lifted.
Sponsorship in US
Must be eligible to work in the U.S. without Sponsorship
CareFirst, Inc. is the not-for-profit, non-stock, parent company of CareFirst of Maryland, Inc. and Group Hospitalization and Medical Services, Inc., affiliates that do business as CareFirst BlueCross BlueShield. CareFirst, Inc. is governed by a Board of Directors and special statutes regulating its business in Maryland, the District of Columbia, and Northern Virginia.