Jobs at Blue Cross and Blue Shield of Minnesota

Lead and manage enterprise accreditation activities to ensure NCQA compliance and survey readiness. Oversee documentation, evidence collection, readiness assessments, reporting, and accreditation lifecycle. Partner with cross-functional leaders to interpret standards, develop policies and processes, provide training and consultative guidance, manage accreditation risks, and drive quality improvement across clinical programs. Supervise an accreditation team and coordinate organizational performance for successful accreditation outcomes.

Lead the annual HEDIS program, overseeing project planning, training, vendor onboarding, QA/over-read processes, and operational oversight. Manage a team of clinical consultants and analysts, drive performance on quality measures, analyze metrics, identify improvements, and maintain documentation to support continuous improvement and readiness for future cycles.

As Manager of Sales Technology, you will oversee enterprise sales technology platforms, ensuring their effectiveness, compliance, and alignment with strategic goals while leading a team and managing vendor relationships.

Administer member enrollment and eligibility accurately and timely. Collaborate with teams and vendors, document actions across systems, resolve inquiries, identify workflow improvements, and support membership operations under regulatory guidelines.

Administer client and member invoicing, process payments and reconciliations, research and resolve billing discrepancies, provide phone and written customer support, protect PHI, collaborate with cross-functional teams, and identify workflow improvements to ensure accurate, timely billing and member satisfaction.

Lead design, development, and maintenance of identification and stratification models and recurring production workflows for care and utilization management. Perform data ingestion, feature engineering, modeling, deployment, performance tracking, and documentation. Mentor junior data scientists and collaborate with clinical, product, and engineering partners to translate business needs into actionable ML solutions and communicate results to stakeholders.

Manage and grow assigned group accounts by retaining and expanding business, leading renewals and contract negotiations, supporting RFPs, maintaining account plans and Salesforce records, presenting to brokers/clients, coordinating implementation, and meeting retention and growth targets for medical and ancillary products.

Lead a team conducting risk-based compliance assessments and monitoring across internal operations and external partners (FDRs/subcontractors) for Medicare, Medicaid, and ACA programs. Oversee corrective action plans, provide regulatory guidance, support external audits, report to leadership and boards, and strengthen oversight frameworks while fostering compliance culture and continuous improvement.

Lead and manage the Account Advisor team serving commercial accounts (2–2,000 lives). Ensure client/broker needs are met, oversee account servicing, drive retention and margin strategies, lead cross-functional implementations and process improvements, provide subject-matter expertise on initiatives, and support escalation or tactical client needs including occasional travel.

Lead sales and account management for local markets across Individual, Medicare Advantage, Small Group, Mid-Market and Specialty segments. Develop and execute strategic sales and business plans, set quotas and forecasts, mentor teams, collaborate cross-functionally, oversee contracts/compliance, pursue growth and retention, and monitor market and regulatory trends to meet membership and financial goals.

Lead technical actuarial work for risk adjustment across Medicare, ACA, and Medicaid. Develop and validate assumptions and models, analyze claims and financial impact, support forecasting, pricing, and audit defense, and translate findings for business partners and senior leaders. Partner cross-functionally and provide guidance to actuarial staff on complex risk-adjustment projects.

Manage claims overpayment identification and recovery activities, lead a team, oversee vendor relationships, drive data mining and process development, perform trend analysis and reporting, allocate resources to meet recovery and budget goals, and ensure performance standards and business integration.

Lead strategy and execution for major commercial accounts, driving growth, retention, and financial targets. Build and coach a high-performing sales and account management organization, coordinate cross-functional partners, develop business plans, and maintain key client and distribution relationships.

Partner with business leaders to deliver HR services including benefits administration, employee relations, onboarding/offboarding, performance and talent management, HRIS (Workday) updates, policy compliance, reporting, and coaching. Support HR initiatives, conduct fact-finding on employee concerns, and collaborate with centers of excellence to build capability and an inclusive environment.

Lead technical design and delivery of enterprise data warehouse and BI solutions. Own data architecture, complex ETL/ELT development, testing, performance tuning, and prototyping. Mentor teams, coordinate cross-functional resources and vendors, enforce best practices, and ensure data readiness and quality to enable analytics and business value.

Manage complex commercial client and account operations including renewals, onboarding, benefit management, documentation, data validation, and process automation. Serve as SME, lead cross-functional initiatives, create/test code changes and tools, integrate vendor platforms, escalate/resolving data issues, and ensure compliance and stakeholder communication.

Manage client and account operational tasks across the commercial client lifecycle, including renewals, onboarding, benefit management, data validation, document drafting, and stakeholder communication. Drive process improvements, initiate system requests, respond to data inquiries, and provide subject-matter input to optimize client experience and operational outcomes.

Lead end-to-end executive searches for C-suite, VP, and Senior Director roles. Build executive talent pipelines, conduct market mapping and targeted sourcing, evaluate candidates for leadership and fit, counsel senior stakeholders, manage search process through offer and onboarding, and coordinate assessments or external partners as needed.

The Senior SAP ERP Developer will design, code, and develop software for the financial management platform, providing support and leading projects while collaborating with various business partners.

Lead Utilization Management operations, ensuring efficient prior authorization, concurrent and retrospective reviews, compliance, performance monitoring, vendor collaboration, and staff leadership to deliver cost-effective, high-quality care aligned with product strategy and financial targets.