case manager

registered nurse case manager

senior business analyst

principal

business analyst

Blue Cross and Blue Shield of Minnesota

Responsibilities: 
•	Leading Testing team for Claims, Benefits. ISC and Pharmacy (RxTPM) Towers, in order to meet the quality deliverables. And updating the project status to customer and IBM management. 
•	Leading Testing Team for ISC Project
•	Monitored and reported on testing activities to Client
•	Responsible in Creating Test strategy Document, Test Plan Document, conducting walkthrough with business, development team and obtaining approval with project leadership and key stakeholders.
•	Responsible in preparing requirement traceability matrix to make sure Business requirements are properly mapped with Test scenarios 
•	Responsible in preparing End to End test Plan for cross functionality application testing
•	Identifying, managing and creating test data for various testing levels and also protecting 
•	Perform static testing, walkthroughs, traceability meetings and sign-off on all test scenario’s and test cases from Business and Development team managers
•	Ensure Team will perform Effective Peer reviews on Test case design document before walkthrough with all stakeholders
•	Monitor Test execution by team and mentoring and guiding them to perform effective test execution and documenting results
•	Defect tracking and reporting to management on time
•	Conducting Test results reviews with Business Users, SME’s and development team
•	Indentifying Automation scope and coordinating with automation team for Creating effective Automation framework and Scripts
•	Managed with vendor personnel to resolve defects, facilitate build/promotion decisions.
•	Maintaining all artifices for auditing and creating Audit folder
•	Getting Sign-off on testing completion
•	Getting Sign-off on SLA

Blue Cross Blue Shield in Eagan, MN was a wonderful place to work. They have an excellent training program for new employees, and also offer numerous training opportunities on a daily basis throughout the year. A typical day of work required that I have excellent organizational skills, communication skills, accountability, utilize many different computer programs, work with staff from various disciplines such as case managers and psychiatrists, have the opportunity to build relationships with providers, and opportunity to share knowledge regarding SPMI, Dual Diagnosis, Community Services, CADI, CAC and TBI waivers and Chemical Dependency as well as information pertaining to Psychiatric Diagnoses and Psychotropic Medications. My co-workers were wonderful team players. Everyone made themselves available when help was needed. I enjoyed all parts of my job even the more difficult aspects such as speaking with a parent when their child did not meet the medical necessity criteria for a certain level of care. I respected my manager as she always kept our team abreast of the many changes which are typical in the insurance industry. She was an advocate for us all and an excellent leader.

Although I hear some different things from the customer service side of the building, the claims side is fantastic! A typical day at work is relaxed, sitting at an ergonomical desk you work mainframe and web systems to process medical claims according to a very high quality set of standards. Training is very thorough and lengthy so nobody leaves feeling lost and there are experts who are there to help. Management is friendly and very helpful and accommodating to most reasonable situations. Coworkers are friendly and there are often opportunities to volunteer, get healthy, work on projects, give back to the community, and throw little fun parties (during breaks or outside of work) for each others life achievements - and there's absolutely no pressure if you don't want to! The best part of this job is the amount of voice each person has - if you don't understand something, or if you notice a trend, THEY LISTEN and will get things done! The hardest part, I think, is that sometimes the work can be repetitive, but not always - it's like solving puzzles all day! And you get paid for that!

I can go to work and prioritize my day depending on reports I receive and correspondence I receive from my technical specialist and supervisor.   I work towards our my daily goal of completed claims each day, but also know that quality is more appreciated and can take the time to work through those claims that require extensive research.  

I have learned from my time at BCBSMN is that I am very self motivated, i enjoy learning new programs and skill levels.

The management team is one of the best I have worked with.  They are compassionate about what BCBSMN does to help not only their employees, but also the community.  I have found them easy to approach and discuss any questions or concerns.

I appreciate the diversity we have at BCBSMN.  We have people from all backgrounds, and to help support the staff we have the ability to join different groups to connect and relate with others.

The hardest part of my job is staying excited at times because the work can be very repetitive. 

The most enjoyable part of my job is the comfortable atmosphere.  It is laid back in that we can make our space our own.  I enjoy being able to go to work, and do what I need to do, and go home and not worry or think about what happened that day.  It is a great work,life,family balance.

A typical day at work is looking at a list of people that I manage their cases. I review which ones should be called and when. I spend my day connecting with members and meeting their needs as best as I can which includes educated members, connecting them to the right areas that can help them, review gaps in care, etc...
I have learned so much...How the health care system works, how to communicate with others, meeting member's needs where they are at in their life, help people live better and longer and other things...
There are teams of people that range from 10-15 people and each team has a manager that monitors the team's work, performance and other leadership skills
Co-workers sit all through the call center and have similar jobs but may work with different insurance groups and some are more involved in Disease Management and some are more involved with Case Management
The hardest part of the job is keeping up with metrics. Just making sure you are meeting the needs of the member and completing the job to the Employer's satisfaction
The most enjoyable part of the job is connecting with members and knowing the I am making a difference in their life.

I would say just an okay place to work. The benefits are great but working in a call center is frustrating. This place is very disorganized. In my role I deal with mainly insurance agents, who complain how downhill the company had gone in recent years daily. Issues never get resolved and management is unwilling to help. When I took the position I was under the impression that bonuses would be adequate (possibly an extra couple thousand dollars a year). Not the case at all.bonuses are maybe an extra $150-$200/quarter if you're lucky. My first "bonus" was $80. Really not worth all the bs you deal with. Also told you can advance and move into a different role within a year, it's more like 2-3. There's a really high turn over rate and training is a bit over the top, considering most of my knowledge was gained on the job. Training was about 18 weeks, which is ridiculous for this type of position. Attendance policy is based on a points system. An absence is 1 occurance, tardies are on a 1/4 of an hour basis. If you accrue 12 you are terminated. I  have gained a lot of knowledge in the healthcare field and have decided to pursue a career in that fiend, so that is one of the positives.

I worked there as part of the company’s move from on-prem to cloud. Great opportunities for working with new technologies. The pay was decent, and benefits pay out better there than at other companies (as one should expect working for a health insurance company). Likewise, management and team members are very flexible with work/life balance. BCBSMN has been proactive pursuing cloud technologies, both Azure / O365 and AWS, implementing collaboration solutions, e.g. Teams, and enabling remote work.

Unfortunately, BCBSMN’s move to the cloud is part of their greater struggle to stay ahead of operating losses, which has been ongoing for a few years (financial reports available on BCBSMN’s news page). Be mindful of things like that, as they can be red flags for layoffs down the road. If you do get laid off, though, you at least get notice weeks in advance, re-employment assistance, severance package, and unused PTO payout.


A typical day about work would be on the phone answering 100  or more calls in a 8 hours day.

Paying close attention to details of the claims and each customers chief complaints.

Also  would have to make outbound calls to Clinic, other insurance companies, hospitals, pharmacies, Dentist offices, and customers.
Verifying  helpful information in order to resubmit a in correctly paid claim, back to the claims offices via window excel. And informed them on the CPT & ICD-9 Codes, to use in order to get the claims processed correctly.

I learned to be efficient, presistant, and a person of my word to the clients, in order to resolve their compliants.

I had to take the initiative to try in resolve every customer complaint without involving my Supervior, or Manager.

My co-workers and I worked close together when necessary.

The hardest part of the job was being able to solve every issue as quickly, as I would have liked too.

The most enjoyable part of the job. Was I developed my listening skills, was able to assist the customers in a timely matter. Sometimes it had to be done by me returning their phone call once

My experience at Blue Cross has been challenging, and overall disappointing. I was not under the impression that I would be working in call center environment and they mislead me into thinking that I would be closing once a month. I am required to close two nights a week. They gave me two full weeks of training for a job that requires at least 8 weeks. The medical field is complex and there are a lot of systems I had to learn in a short period of time. There are expectations are much to high for the pay grade. I have learned a lot in this position which has made me grow, and I can take with me to my future position, and I enjoy being challenged within a position so it has fulfilled those expectations. You have to be very flexible, there was a high turnover many employees only last a few months it takes a very particular person to be able to fulfill this job I excelled my manger and supervisor gave me great reviews. I am responsible for assisting members and providers with their health insurance benefits, claims and eligibility.

The best metric to view how good a company is to work for is turnover/job retention rates. Blue Cross entry level positions in my department had turnover rates of 75-80% after three months and 90% after one year. Most of the losses were due to people quiting, a smaller amount from people getting fired, and a tiny fraction got approved for transfers to lower stress, but lower paying departments. Low to mid level management appeared to have the same turnover issues as I worked for 4 plus years and had 5 different supervisors in that time frame. Stresses from constant micromanagement, lack of coordination between departments, outsourced IT, difficult-to-meet bonus structures, and the public increasingly seeing insurance companies as the villains in health care make BCBS a difficult place to work for (No matter how many pot lucks and "keep up the good work" cakes there were)

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