Jobs at Blue Cross Blue Shield Association

Lead brand strategy and support customer experience by translating research and consumer insights into strategic direction, creative briefs, and recommendations. Drive system-wide brand initiatives, partner with plans and cross-functional teams, and present strategy to leadership using AI-enabled tools to accelerate analysis and deliver aligned brand and marketing priorities.

Lead the Medicare compliance program by operationalizing CMS requirements across Part C and Part D. Provide subject-matter expertise on claims, pharmacy, UM, appeals; design policies, training, monitoring, audits, investigations, CAPs, and risk assessments. Liaise with operations and FDRs to embed compliance into workflows and support audit-readiness and governance reporting.

Leads the financial and operational internal audit plan, directing concurrent audits, supervising audit staff, reviewing audit quality and findings, and advising senior management. Oversees risk assessments, internal controls, audit reporting, strategic improvement initiatives, and quality programs. Evaluates and deploys AI-enabled audit tools, prepares executive and committee presentations, manages audit issues, and coordinates with enterprise risk, compliance, and information security functions.

Conduct qualitative and quantitative analyses on health financing policy, develop analytical models, manage research projects and vendor work, maintain research repository, produce monthly updates, and present findings to inform BCBSA policy priorities on affordability, reimbursement, and drug pricing.

Provide expert functional support and business analysis for PeopleSoft Financials: troubleshoot production issues, gather requirements, design solutions, lead implementations/upgrades, manage testing and projects, develop training and documentation, and drive process and system enhancements to improve efficiency and reporting.

Lead product strategy and roadmap for healthcare analytics and AI/agentic products. Own end-to-end product lifecycle, translate market and customer needs into actionable features, ensure compliance (HIPAA, SOC 2), mentor product teams, and partner with engineering, data science, and commercial teams to deliver scalable, AI-enabled solutions for payers, providers, and healthcare stakeholders.

Lead HEDIS data quality strategy and operations, oversee portal and QCR profiling, perform advanced data analyses, coordinate cross-functional partners, ensure NCQA-compliant reporting, and drive continuous improvement in HEDIS processes.

Lead federal advocacy strategy to advance BCBSA legislative and regulatory priorities. Build and sustain relationships with Members of Congress, staff, Administration officials, and stakeholders; monitor congressional activity; provide strategic guidance and executive presentations; coordinate cross-functional and Blue Plan advocacy efforts; leverage political resources and partnerships to influence federal policy affecting the insurance industry.

Design, build, and optimize scalable data pipelines for large-scale structured and unstructured healthcare data to support ML and GenAI workloads. Implement ingestion, transformation, validation, orchestration, monitoring, and data foundations (feature pipelines, embeddings/vector stores). Collaborate with architects, data scientists, and DevOps to deploy and secure cloud-based pipelines while ensuring compliance with SOC 2, HIPAA, and GDPR. Mentor junior engineers and drive best practices in version control, metadata, reproducibility, performance tuning, and cost optimization.

Lead strategy and execution for enterprise data and AI/ML platform as a product. Own roadmap, delivery, adoption, and value tracking for foundational platform products (ingress/egress, data quality, engineering agents, AI/ML platforms). Manage portfolio, build business cases, mentor teams, drive cross-functional alignment, and ensure measurable business outcomes while balancing modernization and technical debt.

Lead Accreditation and Quality operations for FEP, set strategy for QCR measures, ensure compliance with HEDIS/NCQA/URAC, manage cross-functional accreditation projects, develop programs to improve member care, oversee budgets, and lead a department to meet Plan and accreditor requirements.

Lead cross-functional accreditation projects for Federal Employee Program and Blue Plans. Serve as subject-matter expert for NCQA and URAC accreditation, develop submission documentation and tools, provide delegation oversight, conduct mock surveys, present accreditation guidance to plans, and translate trends into strategic action plans to ensure compliance and successful surveys.