Senior UW Clinical AnalystAuditor
Senior UW Clinical AnalystAuditor
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Job Description
About Blue Cross and Blue Shield of Minnesota
At Blue Cross and Blue Shield of Minnesota we are committed to paving the way for everyone to achieve their healthiest life. We are looking for dedicated and motivated individuals who share our vision of transforming health care. As a Blue Cross associate you are joining a culture that is built on values of succeeding together finding a better way and doing the right thing. If you are ready to make a difference join us.
The Impact You Will Have
This position is responsible for researching analyzing collecting updating and making eligibility decisions for New and renewing Individual/Small Group business and Medicare Supplement health history applicants. This position will mentor other analysts/ auditors and underwriters and assist with complex case reviews to ensure the data is accurate and defined according to business/system rules standards and regulations; and underwriting guidelines.
Your Responsibilities
- Responsible for a book of business.
- Analyzes risk factors for new Individual or Small Group enrollment and renewal groups in conformance with established underwriting/eligibility policies practices and standards.
- Analyzes risk factors for Medicare Supplement health history applicants and appeals in conformance with established health history underwriting guidelines.
- Perform audits to ensure compliance with ACA guidelines and business practices.
- Develops sound audit work plans and completes eligibility audits all in accordance with department policy and procedures.
- Assists with high cost claim review and provides future claim predictions.
- Proficiency in Microsoft Office Excel Adobe Word and Access databases.
- Recommends modifications to existing workflows and proposes new ideas to enhance efficiency.
- Performs special projects training and assignments as requested.
- Makes decisions relative to handling and distribution of confidential and legal documents (ie; Employer and Employee applications and wage and tax information).
Required Skills and Experiences
- RN/LPN with current MN license and no restrictions or pending restrictions.
- 4 years of related professional experience. All relevant experience including work education transferable skills and military experience will be considered.
- Demonstrated knowledge of Individual and Small Group eligibility and State/Federal Regulations.
- Strong analytical and reasoning skills.
- Medical terminology.
- Strong interpersonal skills.
- Good written communication skills.
- Demonstrated conflict resolution skills.
- Ability to analyze solve problems and make independent judgments.
- Ability to explain complex procedures products and concepts.
Preferred Skills and Experiences
- Bachelors
- Agents license.
Role Designation
TeleworkerRole designation definition: Teleworking is working full time remote. Hybrid is a combination of working onsite and remotely. Onsite is fulltime onsite.
Compensation and Benefits
$67200.00 $89100.00 $111000.00 AnnualPay 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.
Equal Employment Opportunity Statement
Blue Cross is an Equal Opportunity and Affirmative Action employer that values diversity. All qualified applicants will receive consideration for employment without regard to and will not be discriminated against based on race color creed religion sex national origin genetic information marital status status with regard to public assistance disability age veteran status sexual orientation gender identity gender expression or any other legally protected characteristic.
Reasonable Accommodation for Job Seekers with a Disability: If you require reasonable accommodation in completing this application interviewing completing any preemployment testing or otherwise participating in the employee selection process please direct your inquiries to
All roles require a high school diploma (or equivalency) and legal authorization to work in the U.S.
Blue Cross and Blue Shield of Minnesota and Blue Plus are nonprofit independent licensees of the Blue Cross and Blue Shield Association.
Required Experience:
Senior IC
Employment Type
Full-Time
