Provider Solutions Specialist IIIa
Florida Blue - Florida

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Job Description
Provider Solutions - Specialist IIIa - 2597
The work of a Specialist IIIa is guided by practices, procedures, precedents or well-defined policy and/or supervisory review. Incumbents determine their own priorities and may deviate from established procedures and practices as long as the end results meet standards of acceptability.

Job duties include but are not limited to the following:

• Obtains and analyzes data in order to determine root causes of internal and external

customer issues.
• Devises or modifies procedures to solve complex problems. Considers computer

equipment capacity and limitations, operating time, business systems, industry

requirements form of desired results and user need.
• Coordinates the completion of standard and ad hoc reporting.
• Analyzes business and user needs; documents requirements, translates into

functional specifications and manages changes to specifications. Serves as liaison

into IT factories. Negotiates agreements and commitments between business units

and IT.
• Ensures the appropriate planning, preparation and execution of testing activities is

• Develops, creates, presents and facilitates presentations for a variety of audiences.
• Monitors and executes project and/or production support activities. May lead small to

large projects.
• Guides and advises less experienced Analysts.

• Assists in business process redesign and documentation as needed.

• Moderate to heavy keying required.

Job Requirements:
• Bachelor’s degree or equivalent work experience
• 4+ years’ of related work experience.

• Knowledge of Network operation functions

• Knowledge of Project management principles

• Knowledge of SQL and SAS.

• Experience in claims adjudication processes and claim processing systems

• Knowledge of non-claims issues such as remittance advice, eligibility, benefits,

authorizations and referrals

Business Specific Criteria (preferred skills):
• Knowledge of technological trends.
• Strong analytical skills as demonstrated through successful identification and

resolution of provider pricing and business process issues based on root cause


• Knowledge of Availity Self-Service tools

• Knowledge of HIPPA requirements, policies, processes and transactions.
• Knowledge of change management principles.
• Experience with PC and standard office software, including Word, Excel and

PowerPoint.MS Office applications.

Primary Location Jacksonville
Other Locations Lake Mary, Miami, Tampa
Organization Blue Cross Blue Shield of Fla
Schedule Full-time
Posting Deadline Mar 1, 2013, 11:59:59 PM