Reporting Solutions Consultant

We are hiring a Reporting Solutions Consultant I on the Internal Audit team at Blue Cross Blue Shield of Tennessee! In this role, you will serve as a key claims data resource for Internal Audit, retrieving, querying, and analyzing claims data that supports audits across the organization. You will work with claims data tables and reporting tools to fulfill audit-related data requests while also providing data and reporting support to the Claims Payment Integrity team.

This is an opportunity to combine technical claims expertise with broader business exposure, develop an understanding of audit practices, and help Internal Audit improve how the team accesses and uses claims data to support effective, data-driven reviews.

Ideal candidates for the role will bring:
Hands-on experience querying, retrieving, and analyzing healthcare claims data. Knowledge of Facets and familiarity with claims data tables and claims-related systems. Familiarity with SQL or other comparable data querying and analytical tools. The ability to develop queries and extract data to support business and audit requests Strong analytical and problem-solving skills, including the ability to investigate data needs and work through complex or evolving requests.

The ability to work independently, understand the business context behind data requests, and become productive with minimal ramp-up time. An interest in developing audit knowledge and using claims data to support audit reviews.

• Hands-on experience querying, retrieving, and analyzing healthcare claims data.
• Knowledge of Facets and familiarity with claims data tables and claims-related systems.
• Familiarity with SQL or other comparable data querying and analytical tools.
• The ability to develop queries and extract data to support business and audit requests.
• Strong analytical and problem-solving skills, including the ability to investigate data needs and work through complex or evolving requests.
• The ability to work independently, understand the business context behind data requests, and become productive with minimal ramp-up time.
• An interest in developing audit knowledge and using claims data to support audit reviews.

• Preferred qualifications:
  
  Experience supporting healthcare payer claims reporting, analytics, or audit-related data requests.
• Previous auditing experience or experience providing data and analysis in support of audit activities.
• Experience working with claims oversight, validation, or review functions.

• Define requirements, analyze, design, enhance, and develop reporting methods to efficiently and effectively fulfill corporate initiatives and planning/development objectives.
• Assist in determining data requirements and Metadata definitions in the data warehouse environment.
• Effectively administer reporting solutions in a rapid application development environment ensuring short term proof of concepts meet long term objectives.
• Maintain technical skill sets across a broad range of software languages, databases and platforms that will be used in the development and production of analyses and reporting solutions.
• Provides significant input to establishment of reporting protocols, tools, and systems development and enhancement.
• Documents and coordinates complex, cross functional analytic and reporting solution test plans.
• Participate in vendor evaluation and selection processes.

Education Bachelor's Degree or equivalent work experience required. Equivalent experience is defined as 4 years of professional work experience in a corporate environment Experience 3 years - Reporting development and programming experience required.

Skills/Certifications Must have proven analytical and system design skills and demonstrated success in leading large projects or multiple concurrent small to medium projects. In-depth knowledge of systems development life cycle and/or operational maintenance environment Proficient in Micro Soft Office (Outlook, Word, Excel, Access and Powerpoint) Excellent oral and written communication skills.

Number of Openings Available 1 Worker Type:
Employee Company: BCBST Blue Cross Blue Shield of Tennessee, Inc.

BCBST will recruit, hire, train and promote individuals in all job classifications without regard to race, religion, color, age, sex, national origin, citizenship, pregnancy, veteran status, sexual orientation, physical or mental disability, gender identity, or any other characteristic protected by applicable law. Further…