Excellus BlueCross BlueShield

Role Description The IT Cloud Engineer - Security provides the vision, strategy, functionality, and technology solutions for creating and maintaining security systems and solutions for both public and private cloud infrastructure-based solutions. This position collaborates with the Information Technology teams to lead the organization toward the deployment of technologies which focus on the trust, risk, and security management of the company environment. - Enforces and integrates security solutions, tools, and appropriate controls to align to security policies, standards, and procedures. - Stays current with leading security technologies, standards, and best practices as well as cyber threat landscape and evolving mitigation approaches and techniques. - Acts as a high-level escalation tier for operational support in assigned technical areas. - Conducts proof-of-concept testing in a lab environment. - Creates, updates, and maintains supporting documentation for technology standards. - Designs and deploys security solutions to support and ensure alignment with business requirements. - Works with technology vendors and technical subject matter experts (SME) to produce corporate standards with regards to assigned technology areas. - Collaborates and/or leads engineering solutions, integrating multiple systems and/or technologies. - Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values. - Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures. - Regular and reliable attendance is expected and required. - Performs other functions as assigned by management. Qualifications - Level I: Four (4) years of related experience. - Associates degree in Computer Science, Information Technology, or related field. In lieu of degree, three (3) years of related work experience required. Bachelor’s degree preferred. - Intermediate knowledge of security, compliance, and audit policies/procedures. - Basic experience with research, design, and implementation in assigned technologies. - Basic infrastructure operations and infrastructure project delivery experience essential. - Basic scripting and automation experience. - Advanced communication skills. - Intermediate understanding of cloud computing infrastructure and concepts. - Intermediate knowledge of securing cloud and/or on-premises systems. - Intermediate ability to engineer and integrate new security designs. - Demonstrates intermediate knowledge of a minimum of two (2) concepts and/or tools listed below: - Encryption, PKI, Network and application security, and related firewalls (Palo Alto Networks, Imperva, Azure, AWS, etc.) - Identity management (AD, Entra ID, conditional access, MFA, SSO, etc.) - Virus detection and endpoint security (Defender preferred) - Vulnerability scanner and pen testing tools (e.g., Rapid 7, Nessus, Nexpose, Metasploit, Appscan, Burp suite, Ida Pro etc.) - IDS/IPS and related tools - Comprehensive Cloud security platform (Palo Alto Prisma) - Security logging and monitoring (SIEM e.g., ArcSight, Splunk, SolarWinds LEM, Azure Sentinel, AWS Guard Duty, etc.) - Common web application security vulnerabilities (e.g., OWASP) - Application security - Security architecture principles/concepts (i.e., Zero Trust) Requirements - Level II (in addition to Level I responsibilities): - Acts as a primary engineer for assigned technology areas maintaining highly performant and optimized infrastructure environment. - Researches technologies and performs analysis that significantly contributes to budget and expenditures for assigned technology areas. - Collaborates and participates in the development and execution of enterprise strategy in the assigned technology area. - Assists in the RFI/RFP process. - Level III (in addition to Level II responsibilities): - Research and recommend solution designs. - Establishes business justifications for purchases made within assigned technology areas. - Significant contributor to automation workflows and focuses on automation for job-related tasks. - Performs system analysis and capacity planning of security assets. - Assists with mentoring of Level I and II Engineers. - Level IV (in addition to Level III responsibilities): - Acts as trusted advisor to the management team. - Emphasizes technology cost optimization when designing new solutions. - Leads business critical projects efforts for IT infrastructure. - Leads internal strategic efforts, collaborates, and mentors peers. Benefits - Participation in group health and/or dental insurance. - Retirement plan. - Wellness program. - Paid time away from work. - Paid holidays. Compensation Range(s) - Level I - Min 79,068 Max 142,322 - Level II - Min 87,766 Max 157,978 - Level III - Min 98,297 Max 176,935 - Level IV - Min 110,093 Max 198,168 Physical Requirements - Ability to travel across the Health Plan service region for meetings and/or trainings as needed. - Ability to work in a home office for continuous periods of time for business continuity. - Ability to provide on-call rotation support.

Role Description The Pharmacy Analytics Consultant provides direct support for both Pharmacy and Medical Drug information needs using a variety of analytic tools and applications. The Consultant will work with internal and external stakeholders and management, as required, to achieve Pharmacy Markets strategy, growth, compliance, and affordability objectives across the enterprise. The analyst collaborates with a multidisciplinary team (e.g., clinical, financial, sales, and Line of Business Leaders) to recommend actionable items leading to positive pharmacy financial performance. This position prepares and presents information to enable both senior management and our customers to better understand, evaluate, and support their goals. Essential Accountabilities - Perform research on projects and manage and lead projects to successfully meet business objectives from across the enterprise. - Analyze data to determine business problems, trends, or opportunities for process improvements. - Provide consultation and analytic support within the Pharmacy Division, other Health Plan departments, and external vendors to ensure the most effective and affordable Pharmacy Benefit. - Identify needs to develop new and innovative Pharmacy products, perform appropriate research, analyses, and evaluate feasibility of the administration and implementation of products. - Communicate effectively with all levels of the organization related to health plan cost, utilization trends, and savings strategies. - Develop and deliver actionable insights to key enterprise stakeholders. - Conduct comparative pricing analyses for pharmacy benefit Requests for Proposal in partnership with Sales, Finance, and Actuarial. - Provide analytics to support strategy development and innovative programs that align with enterprise and pharmacy goals and objectives. - Partner with business units to ensure compliance with governmental, contractual, and corporate guidelines, regulations, and policies and procedures. - Develop and establish standardized reporting and processes to support maintenance of business activities. - Stay current with knowledge of Health Plans tools and data sources/structures to accurately pull and deliver data. - Compile complex data sets tailored to customer needs and provide actionable insights. - Consult with other specialized analytic units to develop automated production reports, dashboards, and cubes for efficiency. - Engage with external partners and customers to help drive the success of Health Plan partnerships and goals. - Enhance Pharmacy knowledge and consulting skills to contribute to affordability and savings for the Enterprise and our customers. - Create unified strategies with internal departments that target reducing costs of healthcare. - Manage, organize, and prioritize tasks for multiple projects with competing deadlines. - Collaborate with team members, leveraging skill sets across the team and aiding in growth and development as needed. - Proactively problem solve and bring forward concerns to management and/or business partners. - Build collaborative relationships across functional teams and other analytic teams across the organization. - Maintain high regard for member privacy in accordance with corporate privacy policies and procedures. - Perform other functions as assigned by management. Minimum Qualifications - Bachelor’s degree in Mathematics, Statistics, Medical Informatics, Economics, or related field preferred. - Minimum of two related years’ experience in data or information analyses and reporting in lieu of a degree. - Knowledge and applicable use of all tools available to develop analyses, extract information, and use the most appropriate tool for the given report. - Proficient in using SAS and/or Cognos and Microsoft tools. - Working knowledge of Microsoft Office Suite. - Knowledge of basic statistical concepts and strong analytical and problem-solving skills with attention to detail. - Ability to take complex data sets and simplify for all audiences. - Willingness to develop relationships with partners within the health plan. - Demonstrates intermediate understanding of healthcare products and operational business knowledge. - Excellent oral and written communication skills. - High degree of initiative, proactive attitude, and commitment to teamwork. - Ability to work collaboratively with requestors and/or business partners. Compensation Range(s) - E1: $62,400 - $84,000 - E3: $2,400 - $106,929 Physical Requirements - Ability to work prolonged periods sitting at a workstation and working on a computer. - Ability to work while sitting and/or standing while at a workstation viewing a computer. - Typical office environment including fluorescent lighting. - Ability to work in a home office for continuous periods of time for business continuity. - Ability to travel across the Health Plan service region for meetings and/or trainings as needed.

Role Description The Account Sales Consultant is responsible for prospecting new sales while providing service solutions for existing accounts. In accordance with established annual sales and retention goals, the Account Sales Consultant will provide existing accounts and brokers with education, benefit consulting, guidance, and coordination of benefit plans. Accounts are a mix of experience rated accounts including fully insured and self-funded. This group manages medical and all ancillary lines of business for accounts with over 100 full-time equivalents. - Establishes, develops, and maintains positive business relationships with prospective and current clients, brokers, and internal department contacts. - Researches accounts and generates or follows through on sales leads. Coordinates sales effort with team members and other departments. - Performs cost-benefit and needs analysis of existing/potential customers to meet their needs. - Responsible for providing solutions to groups to ensure account satisfaction. - Conducts open enrollment meetings with broker partners and group representatives to review existing benefits and educate/update on new benefits. - Conducts regularly scheduled meetings (monthly/quarterly) with broker partners for training and informational purposes. - Expedites the resolution of customer problems and complaints to maximize satisfaction. - Responsible for maintaining client detail (existing, at risk, etc.) and prospect history. - Prepares and participates in educational programs such as health fairs and Wellness seminars. - Attends meetings, sales events, and trainings to keep abreast of the latest corporate, national, and legislative developments impacting health care benefits. - Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values. - Maintains high regard for member privacy in accordance with corporate privacy policies and procedures. - Regular and reliable attendance is expected and required. - Performs other functions as assigned by management. - Manages more complex relationships involving group leaders, brokers, senior management, and internal departments. - Mentors newer account consultants/service reps. - Proactively seeks participation in internal projects. - Stands in for management when meetings are delegated. Qualifications - Valid NYS Accident and Health License is required within six months of employment. - Highly motivated and target driven with two (2) or more years of experience in direct sales. - Proven ability to build productive professional relationships. - Strong business acumen with ability to explain financial aspects of rate determination, renewal, and underwriting. - Ability to create and deliver presentations tailored to audience needs. - Familiarity with different sales techniques and pipeline management. - Excellent oral and written communication skills. - Ability to adapt and respond to diverse and unexpected situations. - Must have and maintain a valid NYS Accident and Health license. - A proven track record of four (4) or more years in direct sales. - Exceptional analytical/problem-solving skills. - Demonstrated mentoring/leadership skills. Requirements - Ability to travel across the Health Plan service region for presentations, meetings, and/or trainings as needed. - Ability to work while sitting and/or standing at a workstation viewing a computer and using a keyboard, mouse and/or phone for three (3) or more hours at a time. - May be required to transport sales collateral/materials to and from meetings/events. Benefits - Compensation Range: Minimum: $62,400 - Maximum: $96,081. - Participation in group health and/or dental insurance. - Retirement plan. - Wellness program. - Paid time away from work. - Paid holidays. Please note: There may be opportunity for remote work within all jobs posted by the Excellus Talent Acquisition team. This decision is made on a case-by-case basis.

Role Description This role provides the vision, strategy, functionality, and technology solutions for creating and maintaining distributed platforms for both public and private cloud infrastructure-based solutions. This entails the design and use of flexible platforms that deliver features, functionality, and services compatible with industry-leading providers while allowing legacy systems to interact safely when required. This position requires the necessary skills to provide technology research, evaluation, development, and delivery in support of infrastructure deployment solution lifecycles. This position collaborates with the Information Technology teams to lead the organization toward the deployment of technologies that may include PaaS, SaaS, hosted, and on-premises solutions – which will allow for flexible, secure, on-demand cloud-like functionality and services while endeavoring to provide resiliency and achieve cost reduction, while maintaining a highly secure and flexible environment. Qualifications - Level I: - In lieu of degree, seven (7) cumulative years related work experience required. - Associates degree in Computer Science, Information Technology, or related field with four (4) years of related experience required. - Bachelor’s degree preferred. - Awareness of security, compliance, and audit policies/procedures. - Experience with research, design, and implementation in assigned technologies. - Infrastructure operations and infrastructure project delivery experience essential. - Scripting and automation experience. - Strong communication skills. - Understanding of cloud computing infrastructure and concepts. - Knowledge of cloud and/or on-prem integration (i.e.: ability to integrate disparate systems). - Demonstrates intermediate knowledge of a minimum of three (3) concepts and/or tools listed below: - VMware, Nutanix, or similar virtualization platform administration - Windows and/or Linux/Unix server administration - Azure - AWS - GCP - Terraform (or related IaC tool) - Ansible (or related configuration management technology) - Nutanix (or similar hyperconverged technology) - Vmware ESXi (or similar virtualization technology) - Linux - Windows Server - YAML (or similar markup) - JSON - REST API - GitHub (or related Git repository) - Azure DevOps - CI/CD - Level II (in addition to Level I qualifications): - Intermediate knowledge of a minimum of four (4) concepts and/or tools listed above. - Intermediate Infrastructure operations and infrastructure project delivery experience. - Demonstrates strong technical documentation ability. - Experience with IT computing resource management and optimization. - High degree of business maturity and demonstrated confidentiality; executes good judgment. - Strong scripting and automation experience. - Intermediate knowledge of Disaster Recovery. - Intermediate knowledge of security, compliance, and audit policies/procedures. - Level III (in addition to Level II qualifications): - Advanced knowledge of a minimum of four (4) concepts and/or tools listed above. - Advanced understanding of Disaster Recovery procedures related to IT infrastructure. - Ability to provide internal mentorship within team. - Professional certification in job-related technology. - Strategic vision in alignment with business objectives. - Level IV (in addition to Level III qualifications): - Advanced knowledge of a minimum of five (5) concepts and/or tools listed above. - Demonstrated competence in team leadership/technical leadership, facilitation, and project leadership. - Extensive knowledge of hybrid cloud environment. - Proven ability to act as a mentor for peers. Requirements - Acts as a high level escalation tier for operational support in assigned technical areas. - Conducts proof-of-concept testing in a lab environment. - Creates infrastructure design documents to outline production deployments. - Creates, updates, and maintains supporting documentation for technology standards. - Deploys new technology to production environment. - Designs infrastructure solutions to support business requirements. - Ensures assigned technologies are in alignment with the business. - Researches and implements hybrid cloud technology. - Supports high-level strategy for enterprise server environment. - Works directly with business stakeholders to gather IT infrastructure requirements. - Works with technology vendors and technical SMEs to produce corporate standards with regards to assigned technology areas. - Integrates multiple systems and/or technologies. - Acts as a team player with a high level of interpersonal skills. - Regular reliable attendance is expected and required. - Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies' mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs. - Executes good judgment and demonstrates personal accountability. - Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures. - Performs other functions as assigned by management. Benefits - Participation in group health and/or dental insurance. - Retirement plan. - Wellness program. - Paid time away from work. - Paid holidays. Compensation Range(s) - Level I Min 79,068 Max 142,322 - Level II Min 87,766 Max 157,978 - Level III Min 98,297 Max 176,935 - Level IV Min 110,093 Max 198,168

Role Description The Customer Care Advocate (CCA) resolves customer inquiries via various channels concerning contract benefits, claim payments, and enrollment in accordance with LOS, Corporate Service strategy, NCQA, and legislative requirements. The CCA provides service for customers and business partners while enhancing member & provider satisfaction/retention. The B version of this role requires fluency in Spanish. - Provides service among customers and business partners while enhancing member and provider satisfaction and retention. - Documents, researches, interprets, and responds to inquiries from internal and external customers, business partners, and special groups concerning our products, services, and policies. - Utilizes appropriate resources to resolve customer inquiries accurately & efficiently. - Provides outreach related to claims, onboarding, effectuation, retention, provider inquiries, and other complex inquiries. - Demonstrates willingness to adapt and be flexible to changes and business needs. - Participates in meetings, training, and skill development to support career path and individual development plans. - Is knowledgeable and enthusiastic about the company and our products and/or services. - Identifies and follows through on issues impacting the Health Plan and customer experience. - Develops effective internal working relationships for improved communication and collaboration. - Shares ideas and solutions to improve processes, procedures, and systems. - Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values. - Maintains high regard for member privacy in accordance with corporate privacy policies and procedures. - Regular reliable attendance is expected and required. - Performs other functions as assigned by management. Qualifications - High School diploma or equivalent, customer service experience preferred. - Entry level position. Duties performed under close supervision. - B Version: Bi-lingual English/Spanish required. - Ability to multi-task to efficiently resolve customer concerns. - Computer skills required, including the ability to navigate in a Windows environment. - Organizational skills, reasoning, problem-solving skills, effective communication, and ability to prioritize. - Successfully attends and completes all training as defined by the business unit. Requirements - Level II - in addition to Level I requirements: - Rating of “Performing” or above on the Agent Dashboard for a minimum of 9 out of 12 months. - Ability to efficiently resolve complex & escalated issues with minimal direction. - Advanced system and navigational skills. - Expanded communication skills across multiple channels. - Takes accountability and ownership of issues and resolution with minimal supervision. - Level III - in addition to Level II requirements: - Rating of “Performing” or above on the Agent Dashboard for a minimum of 10 out of 12 additional months. - Self-sufficient in resolving complex & escalated issues. - Provide mentoring and support to new hires and peer group. - Assist with tasks assigned by management that require advanced problem-solving skills. - Demonstrates functional global thinking and takes initiative to recognize opportunities within the team. Physical Requirements - Ability to work while sitting and/or standing at a workstation viewing a computer and using a keyboard, mouse and/or phone for three (3) or more hours at a time. - The ability to hear, understand, and speak clearly while using a phone, with or without a headset. - Ability to travel across the Health Plan service region for meetings and/or trainings as needed. Compensation Range(s) Grade N2: Minimum $20.00 Maximum $20.00. The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position’s minimum qualifications.

Role Description The Document Solutions team focuses on the design and creation of correspondence and transactional statements using various software programs. The Publishing Systems Engineer operates in a business analyst/document-generation specialist role as part of the Document Solutions team. This role focuses on programming within the various systems utilized by our Solutions Team. Essential Primary Responsibilities/Accountabilities: - Develops code; analyzes, researches, and resolves system issues for electronic publishing-related problems. - Creates, maintains, and follows all documented processes and standards. - Builds new and updates existing workflows and documents using XML and text data in variable data composition systems based on the requirements and functional specifications. - Documents functional specifications and solutions for work to be performed. - Develops or assists in the development of systems testing and implementation plans. Reviews test results to ensure compliance with design specifications. - Participates in business requirement planning and analysis sessions. - Identifies best practices and participates in creation of Organizational Standards. - Performs basic maintenance of document composition tools utilized at the Health Plan. - Participates in on-call production support rotation. - Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs. - Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures. - Regular and reliable attendance is expected and required. - Performs other functions as assigned by management. Level II (in addition to Level I essential responsibilities/accountabilities): - Provides Second Tier troubleshooting of electronic publishing applications. - Analyzes, researches, and resolves data-related issues within Document Services. - Identifies best practices and drives creation of Organizational Standards. - Participates in strategic discussion and decision-making when called upon to do so. - Communicates with outside departments to develop and maintain first-hand knowledge of their plans, operations, problems, and opportunities. - Participates on projects as a Subject Matter Expert for transactional documents and correspondence. - Performs advanced maintenance of document composition tools utilized at the Health Plan. - Maintains familiarity with latest tools and techniques for project management, system analysis, system design, and programming – specifically as related to electronic publishing. - Mentors Associate Developers. Level III (in addition to Level II essential responsibilities/accountabilities): - Assists with software and system design and architecture within the assigned portfolio. - Monitors and maintains appropriate levels of hardware and operating software that serves as platforms for supported electronic publishing systems. - Administers electronic publishing related computer systems and processes – MISPrint, Q-Direct, StreamWeaver, and uses document archival systems such as Control-D, Filenet, Alfresco, etc. - Reviews service requests and consults with executive sponsors, requesters, and/or user representatives to clarify intent, discuss problematic areas, and consider alternate solutions. - Assists the business with planning for document generation, printing and mailing so they can meet mandated deadlines. - Identifies ways to automate manual processing steps and works with other team members and the business owners in implementing that automation. - Mentors Associate and Mid-Level Developers; provides limited mentorship to other Senior Developers in their technical area(s) of expertise. Qualifications - Bachelor’s Degree in Computer Science or related field. In lieu of Bachelor’s Degree, an Associate degree in Computer Science or Electronic Printing with two or more years’ experience in computer science, electronic publishing, or related field, or a combination of experience and education with programming. - Experience using Variable Data composition. Knowledge of integration tools such as HP Command Center, HP Exstream, Elixir Tango, GMC Inspire is a plus. - Demonstrated analytical and problem-solving skills, excellent proofreading skills, and ability to work well as part of a team. - Knowledgeable of publication layout and design. - Demonstrated creativity and competence in design techniques. - Familiarity with database structures: SQL, Oracle, DB2, or similar. - Familiarity with XML, SGML, HTML, or similar data structures. - Familiarity with JAVA and shell scripts, or other web programming language. - Familiarity with Control-D, Filenet, Alfresco. Similar systems considered. - Demonstrated proficiency in desktop publishing, word processing, and electronic office systems. - Ability to establish effective working relationships with all levels of internal staff and outside professionals. - Strong organizational skills, ability to prioritize assignments, and ability to handle confidential information with discretion. - Good visual acuity, manual dexterity, and typing skills. - Demonstrated ability to “think outside the box.” - Ability to handle multiple projects and requests simultaneously. Requirements - Four or more years of progressive experience in computer science, electronic publishing, or related field. In lieu of degree, a minimum of six years of progressive experience in computer science, electronic publishing, or related field. - Expertise with Variable Data composition and programming is essential. Benefits - Participation in group health and/or dental insurance. - Retirement plan. - Wellness program. - Paid time away from work. - Paid holidays. Compensation Range(s) - Level I E2 - Min 60,410 Mid 76,300 Max 96,081 - Level II E5 - Min 71,880 Mid 100,632 Max 129,384 Please note: There may be opportunity for remote work within all jobs posted by the Excellus Talent Acquisition team. This decision is made on a case-by-case basis. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

Role Description Under the guidance of the assigned EPMO leader, the EPMO Project Manager is responsible for managing and delivering application, operations, ongoing program, and/or business projects for the Excellus Health Plan. - Works with Project Manager Levels II/III/IV to determine project schedules, deliverables, assignments, tasks, project meetings (scheduling and meeting notes), status reporting, communication, and action items, as required. - Works with Project Managers Level II/III/IV and project teams to track work, tasks, and project assignments in order to keep projects on-time and within scope and budget. - Facilitates core team meetings and other relevant project meetings including managing project agendas and minutes. - Creates and manages documents in support of the project Change Management (CMR) process. - Functions as a back-up for Project Manager Levels II/III/IV, as needed. - Performs project management duties over small tier and Enterprise projects or other initiatives as assigned. - Maintains currency on emerging project management techniques and advanced communication mechanisms. - Learns departmental tools required to do the work: Planview, Microsoft Teams, Sciquest, SNOW etc. - Monitors and evaluates quality of performance and product from all work within scope of responsibility. - Always acts professionally. - Fosters an environment of continuous improvement and encourages innovative thinking. - Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values, adhering to the Corporate Code of Conduct and leading to the Lifetime Way values and beliefs. - Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures. - Regular and reliable attendance is expected and required. - Performs other functions as assigned by management. Qualifications - Level I: Bachelor's degree in Computer Science, Information Technology, Business Administration or relevant field (or four additional years related work experience in lieu of degree). - Three (3) years related work experience. - Technically competent with various software programs such as MS Project, Word, OneNote, Excel and PowerPoint. - General knowledge of multiple project methodologies: Waterfall, Agile, SDLC, etc. - Maintains awareness of project management methodologies, processes and deliverables. - Ability to conform to shifting priorities, demands and timelines through analytical and problem-solving capabilities. - Ability to react to project adjustments and alterations promptly and efficiently. - Ability to be flexible during times of change. - Persuasive, encouraging, and motivating. - Strong all-around soft skills and high level of proficiency using written and oral communication skills. - Adept at conducting research when project-related issues occur. - Effectively prioritize and execute tasks in a high-pressure environment. - Strong follow-up skills. - Self-motivated; ability to take initiative and ownership. - Writes and speaks fluently on all aspects of work. - Demonstrated problem solving skills. - Supports and believes in the Lifetime Way values and culture. Requirements - Level II – requires these additional qualifications: - Five (5) years related work experience. - PMP certification preferred, 3 years of Project Management experience can be substituted in lieu of certification. - Demonstrated experience in multiple project methodologies - waterfall, Agile, SDLC, etc. - Demonstrated leadership skills. - Demonstrated skills in developing and achieving project scope, costs, and schedule. - Demonstrated skills in forming and fostering high performance, cross-functional teams. - Writes and speaks fluently on all aspects of work. Communicates effectively with users/customers, and colleagues 2-3 levels up/down and across a range of disciplines, and all levels of management. - Experience drafting concise and informative communication pieces at the Departmental and/or Organizational level. - Experience with Quality principles and tools. Demonstrated problem solving skills. - Very strong analytical and business process development skills. - Demonstrated competence in project leadership tasks. - Ability to maintain poise and composure under pressure and in difficult situations. Benefits - Compensation Range(s): - Level I: Grade E3: Minimum: $62,400 - Maximum: $106,929 - Level II: Grade E4: Minimum: $65,346 - Maximum: $117,622 - Level III: Grade E6: Minimum: $79,068 - Maximum: $142,322 - Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays. - Opportunity for remote work within all jobs posted by the Excellus Talent Acquisition team, decided on a case-by-case basis.

Role Description The Health Outcomes Specialist I-II supports the Health Outcomes & Community Impact (HOCI) strategic plan, goals, enterprise-wide measures, and efforts to achieve improvement across our markets and populations. The role supports the design, implementation, and evaluation of initiatives that improve measurable health outcomes across priority member populations. This role ensures that interventions designed to address disparities lead to demonstrable improvements in clinical outcomes, utilization, community impact, and member experience. Working within the HOCI team, the Health Outcomes Specialist partners with internal stakeholders including Quality, Healthcare Management, Medical Governance, Provider Network, Pharmacy, Data Analytics, and Marketing to operationalize strategies that improve outcomes for members experiencing disproportionate health risks or barriers to care. This role translates population health insights and equity-informed strategies into actionable interventions, program implementation, and outcome measurement. Essential Accountabilities - Partners with leadership on sharing and updating a robust health equity and community health training initiative that spans the entire enterprise as well as externally. - Research and maintains sound knowledge of health equity, evidence-based improvement interventions, industry trends, best practices, and benchmarks to deliver innovative and effective solutions for the management of the HOCI strategy. - Consults on the development of the health equity data infrastructure to ensure appropriate creation of downstream clinical interventions to mitigate health disparities. - Facilitates processes needed to analyze and improve processes and workflows. - Organizes and facilitates large educational and re-engineering sessions. - Facilitates interdepartmental coordination and communication with all Care Management functional areas, such as Case Management, Utilization Management, Behavioral Health, Medical Claim Review and Audit, Health Promotion, Disease Management, to support delivery of high quality, timely customer solutions. - Consults with key internal stakeholders including medical directors, operational and strategic leadership, SMEs, and regional directors as well as external network/other Blues plans regarding the nature of the opportunity identified, potential interventions, and desired and expected outcomes. - Evaluates initiatives and determines key benchmarks in collaboration with health equity stakeholders for its use in subsequent evaluations. - Analyzes, compiles and implements interventions to incorporate into strategic assessments; creates comprehensive strategic proposals to improve health outcomes. - Collaborates with other departments early in the initiative development cycle including quality, provider engagement, customer care, VBP programs, corporate communications/marketing, clinical operations, and others, in regard to cross-functional business processes, program development initiatives and timelines. - Collaborates with the Quality department to facilitate health equity accreditation requirements. - Consults with the CIP team to incorporate a community-based approach on projects, processes and initiatives. - Assesses member, provider and other key stakeholders’ experience related to new or updated initiatives and plans proactively to address their concerns and needs positively. - Oversees vendor relationships associated with vendor partners as needed, including identification of key vendors, nurturing vendor contacts, RFI/RFP creation and strong oversight, pricing negotiations, contract facilitation with legal and other entities, monitoring vendor SLAs/PGs as needed. - Provides reports and recommendations to the Utilization Management/Case Management (UM/CM) team for action. - Responsible for defining, coordinating, and communicating the ongoing monitoring of existing programs in HOCI and other areas as relevant to ensure meaningful intervention outcomes and value are realized and partner with key stakeholders to support strong results. - Serves as subject matter expert in maintaining the UM/CM training program for PHE and other key stakeholder roles. - Represents Medical Services on Health Plan-wide cross functional process improvements teams, as requested by manager/director. - Coordinates HOCI committees to define, prioritize and facilitate initiatives, as appropriate. - Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs. - Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures. - Regular and reliable attendance is expected and required. - Performs other functions as assigned by management. Minimum Qualifications - Minimum of two (2) years’ experience working within a health plan related to Health Equity/Population Health Management or other clinically related program development with Bachelor’s degree in related field. In lieu of a degree, minimum of eight (8) years’ experience working within a health plan in a role related to population health management/case management interventions/programs or other clinically related program development required. - Five (5) years of clinical experience required (RN, LPN, BH, MPH, etc.). - PMP certification preferred. - Working knowledge of best practices and tools related to project management and process engineering/improvement. - Working knowledge of Corporate Medical Policies, InterQual and Milliman & Robertson guidelines, NCQA standards, URAC requirements, HEDIS, CMS requirements, and NYSDOH medical management mandates & program requirements. - Demonstrates effective verbal communication skills and strong writing capabilities. - Developing skills in reading, analyzing and understanding analytics reports and documents. - Understands basic concepts of return-on-investment measurement. - Exhibits excellent organizational, planning, and project management skills. - Makes decisions using solid judgment skills to impact identified problems. - Resourceful and appropriately tenacious in the face of varied opinions to gain consensus. - Exhibits leadership through meeting facilitation. - Subject matter expert on the development of clinical strategic interventions. Physical Requirements - Ability to work prolonged periods sitting and/or standing at a workstation and working on a computer. - Ability to work while sitting and/or standing at a workstation viewing a computer and using a keyboard, mouse and/or phone for three (3) or more hours at a time. - Ability to work in a home office for continuous periods of time for business continuity. - Ability to travel across the Health Plan service region for meetings and/or trainings as needed. - Manual dexterity including fine finger motion required. - Repetitive motion required. - The ability to hear, understand, and speak clearly while using a phone, with or without a headset. - Must have a valid Class D license and ability to operate a motor vehicle. Compensation Range(s) - E2: $62,400 - $96,081 - E5: $71,880 - $129,384 The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position’s minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays. Please note: There may be opportunity for remote work within all jobs posted by the Excellus Talent Acquisition team. This decision is made on a case-by-case basis. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

Role Description Under the direction of the Assigned Management, upon successful completion of all phases of training, and in accordance with established HIPAA regulations, the Enrollment Specialist performs enrollment core processing and servicing in accordance with the Health Plan Operation’s enrollment regulations, Underwriting Guidelines, and applicable government regulations. The focus of this role is to ensure prompt, accurate, and efficient servicing of all broker, member, and group administrator inquiries for all product lines. - Inquiries are received by telephone, email, written inquiries, lobby walk-in customers, and through on-site visits with an employer group. - The B version of this role will require the individual to be on the phone regularly. Essential Primary Responsibilities/Accountabilities: Level I: - Responsible for Government Programs, Small, Mid, and Large Employer Group Subscriber Enrollment Operations. - Maintain communication with Enrollment Management, Account Services Consultants, Sales, Finance/Underwriting, Claims, Customer Care, and external Customers, groups, or Brokers. - Responsible for the enrollment of new groups, renewals, new member, and member movement. - Prepare, process, and maintain all member enrollments utilizing multiple Health Plan enrollment systems. - Review and assess member enrollment activity and associated documents for accuracy. - Research, interpret, and respond to inquiries from internal and external customers, business partners, brokers, consultants, and groups. - Review, validate, and update transaction errors from all member level electronic and paper sources. - Identify issues and respond to all work items brought forward. - Prioritize aged and Performance Guarantee Transactions. - Attend provided/necessary training and participate in meetings. - Execute quality service to external and internal customers. - Maintain high regard for member privacy in accordance with corporate policies. - Regular and reliable attendance is expected and required. - Perform other functions as assigned by management. Level II: - Prepare, process, and maintain all group enrollment utilizing multiple Health Plan enrollment systems. - Handle Designated Record Set (DRS) requests and may serve as a point person for the Account Service team. - Adjust or triage enrollment for subscriber additions, deletions, and changes. - Act as a resource to support and/or cross-train other team members. - Identify issues, patterns, and/or trends affecting compliance and customer satisfaction. - Assist in creating and/or updating operating manuals and/or Desk Level Procedures (DLP’s). - Staff the Enrollment phone lines to resolve inbound telephone inquiries. Level III: - Proficient in most inventory areas and operating systems. - Mentor and collaborate with others on the team. - Serve as subject matter expert for the department. - Process enrollment activities for complex accounts. - Research, respond, and resolve eligibility inquiries. - May assist with system releases and production validation. Level IV: - Create test cases and test processes for new products. - Research complex cases to identify root cause and recommend resolution. - Responsible for complex and/or sensitive cases. - Serve as department representative on corporate projects. Qualifications - Level I: Completed High School Diploma or Equivalent. - Minimum of two (2) years health insurance or related operations work experience preferred. - Solid written and verbal communication skills. - Proven organizational, analytical, and time management skills. - Basic Computer proficiency, including experience in Microsoft Office Suite. - Attention to detail and accuracy. - Ability to multi-task and efficiently resolve customer concerns. - B Version: Ability to actively listen to customers while taking notes. - Level II: Minimum of three (3) years health insurance or related operations work experience preferred. - Rating of “Performing” or above for minimally 12 months. - Organizational, reasoning, and problem-solving skills. - Takes accountability and ownership of issues with minimal supervision. - Level III: Minimum of four (4) years health insurance or related operations work experience preferred. - Must have strong written and verbal communication skills. - Strong Computer proficiency, including experience in Microsoft Office Suite (Excel). - Rating of “Performing” or above for minimally 12 months. - Level IV: Minimum of five (5) years health insurance or related operations work experience preferred. - Rating of “Performing” or above for minimally 12 months. - Self-sufficient in resolving complex & escalated issues. Requirements - Ability to complete work in a traditional office environment under fluorescent lighting. - Ability to arrive on time at work and as scheduled. - Ability to meet minimum performance metrics. - Ability to orally communicate. - Must be able to function while sitting at a desk for 3 or more hours at a time. - Must be able to travel across the enterprise. - Ability to work in a home office for continuous periods of time for business continuity. Benefits - Participation in group health and/or dental insurance. - Retirement plan. - Wellness program. - Paid time away from work. - Paid holidays. Company Description Equal Opportunity Employer Compensation Range(s): - Level I: Grade N2: Minimum: $20.00 - Maximum: $23.89 - Level II: Grade N3: Minimum: $20.00 - Maximum: $26.90 - Level III: Grade N4: Minimum: $20.00 - Maximum: $30.76 - Level IV: Grade N5: Minimum: $20.02 - Maximum: $33.03 The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill, and education as they relate to the position’s minimum qualifications. Please note: There may be opportunity for remote work within all jobs posted by the Excellus Talent Acquisition team. This decision is made on a case-by-case basis.

Role Description The Enrollment Resolution Examiner is responsible for resolving complex enrollment and billing reconciliation issues between the Health Plan and external customers including but not limited to State and Federal Government Agencies, under the general direction of management and in accordance with the objectives and policies of the Health Plan, State and Federal guidelines. The position will work across multiple Enrollment operational areas. - Level I - Responsible for reconciliation of regulatory and Health Plan Enrollment data through audit and review, utilizing the internal and external guidelines/regulations/policies and procedures. - Strong knowledge of reporting and associated regulatory guidelines used to verify enrollment and billing accuracy to ensure plan is paid correctly in order to maintain accurate financial records. - Ensures member and/or group documentation and transactional updates are completed to reconcile account discrepancies. - Receives, reviews and updates discrepancies from internal departments and external customers relating to the Membership subscriber/member/group files. - Investigates, works, analyzes, tracks and monitors operational issues identified during the financial balancing adjustment of funds. - Participates in process and technology improvement efforts to identify and remove barriers to increased productivity, quality, cost effectiveness, timeliness of operations, and customer satisfaction. - Prepares regular and periodic reports for the review and assurance of following processing guidance including but not limited to, the operations reporting of all transactions. - Initiates necessary requests to other operational areas to resolve identified problems or recommendations for process improvement. - Communicates with internal and external customers and provides supporting documentation and makes recommendations for procedure changes based on analysis completed. - Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values, adhering to the Corporate Code of Conduct, and Leading to the Lifetime Way values and beliefs. - Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures. - Be proficient in one line of business and able to process inventory from other lines of business as requested. - Level II (in addition to Level I responsibilities) - Mentors and collaborates with others on the team in utilizing tools, sharing best practices, and serving as a role model within a team unit structure. - Ability to support other team members within your primary line of business by responding to questions, demonstrating key tasks and reviewing work. - Subject matter expert in one line of business and proficient in several inventory areas in other lines of business. - In-depth understanding and working knowledge of the cross-functional enrollment processes as they pertain to the Resolution Examiner work to research and resolve discrepancies or inquiries. - Ability to support implementation of new processes and procedures related to Resolution Examiner inventory work. - Accountability includes but not limited to, creation of test cases, testing of the process, end user testing, creating documents and establishing procedures. - Represents Enrollment Resolution on corporate projects as well as cross-functional work groups, acting as a subject matter expert, providing advice and counsel to project teams and leadership on requirements. Qualifications - Conducting financial analyses and recommendations, or related work experience and proven ability to exercise the requirements and responsibilities of the position required. - Three (3) years’ experience with financial data or Health Insurance Enrollment experience; or an associate degree in finance, accounting, or similar discipline. - Capable of establishing constructive relationships with all levels of internal and external of the organization. - Must be able to prioritize assignments and work accurately and independently within established time frames. - Must be flexible and able to adjust to rapidly changing priorities. - Must have solid communication skills – both verbal and written. - Proven organizational, analytical, and time management skills. - Computer proficiency, including experience in Microsoft Office Suite. - Strong attention to detail and accuracy. Requirements - A minimum of five (5) years health insurance operations experience preferred for Level II. - Ability to represent the department independently as a subject matter expert in discussions with other areas of the company. - In-depth regulatory and Enrollment process knowledge in one line of business and working knowledge in an additional line of business. - Proven ability to support and train peers. Physical Requirements - Ability to complete work in a traditional office environment under fluorescent lighting. - Ability to arrive on time at work and as scheduled. - Ability to meet minimum performance metrics. - Ability to orally communicate. - Must be able to function while sitting at a desk viewing a computer and using a keyboard and mouse for 3 or more hours at a time. - Must be able to travel across the enterprise. - Ability to work in a home office for continuous periods of time for business continuity. Compensation Range(s) - Level I: Grade N5: Minimum: $20.02 - Maximum: $33.03 - Level II: Grade N6: Minimum: $21.83 - Maximum: $34.92 The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position’s minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays. Please note: There may be opportunity for remote work within all jobs posted by the Excellus Talent Acquisition team. This decision is made on a case-by-case basis. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.