Jobs at Blue Cross and Blue Shield of Minnesota

Lead PBM and Medicare Part D operational oversight, build KPIs and dashboards, manage PBM vendor performance and projects, ensure regulatory compliance (PDE/encounter data, FIRs, NX transactions), define oversight processes and controls, collaborate across IT, Pharmacy, Compliance, and handle inquiries, reporting, and audit interactions.

Lead workforce planning for Case Management and Utilization Management by developing forecasts, capacity plans, staffing models, and operational analytics. Partner with operational leaders to forecast demand, analyze call and inventory data, identify risks, and recommend staffing, training, and schedule adjustments. Maintain forecasting patterns, present KPI trends, assess project impacts on capacity, and drive efficiency improvements.

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.

Process and administer member enrollment and eligibility accurately and timely. Collaborate with teams and vendors to resolve inquiries, document actions across systems, analyze data against business and regulatory guidelines, and identify workflow improvements to increase efficiency and accuracy.

Provide high-trust administrative support to a C-suite leader including complex calendaring, meeting and event management, travel and expense coordination, preparation of presentations and reports, handling confidential correspondence, onboarding support, and partnering with admin teams to streamline processes.

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.

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 develop a team of HR Business Partners; serve as strategic HR advisor to executives and leaders; partner on hiring, performance, succession, organizational design, change management, employee relations, and HR data-driven strategy while ensuring compliance and collaboration with HR Centers of Excellence.

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 strategy and roadmap for Utilization Management products, oversee product lifecycle and governance, direct Product Owners and cross-functional teams, partner with compliance, clinical and operations stakeholders, drive performance monitoring, innovation, and alignment of UM capabilities to business, quality, and financial objectives.

Support Identification & Stratification product by maintaining daily program operations, performing member identification analyses, validating clinical indicators and stratification logic, gathering and documenting business requirements, partnering with Product, Operations, and Data teams, supporting agile delivery and sprint planning, and providing actionable insights to target populations and improve care management outreach.

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.

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.

Lead development, execution, and oversight of corrective action plans (CAPs) to reduce compliance and regulatory risk. Conduct root cause analysis, impact assessments, tracking, reporting, and governance support. Partner with business SMEs to translate regulatory requirements into practical processes, monitor CAP progress, and facilitate enterprise compliance committee activities.

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.

Lead and deliver complex, cross-functional compliance and ethics projects. Develop and maintain project plans, KPIs, dashboards, budgets, and communications. Coordinate stakeholders across Compliance, Ethics, Privacy, SIU, and business partners; manage risks, dependencies, vendor contracts, and PMO governance. Prepare executive reporting, coach project teams, and drive process improvement and value realization to meet regulatory and organizational objectives.