Jobs at Blue Cross Blue Shield Association

Lead GTM and enterprise sales efforts targeting Blue Cross Blue Shield plans. Build and manage pipeline, close full-cycle deals, and translate payer needs into product positioning. Align cross-functional teams, influence product roadmap with customer feedback, and ensure compliance with regulatory and security standards.

Plan and lead operational, financial, governance, risk management and compliance audits. Perform project-level risk assessments, develop audit programs, execute procedures, document findings, draft reports, and contribute to the annual risk-based audit plan and quality improvement initiatives including automated audit techniques.

The Director of Audit leads client and pharma rebate audits, ensures compliance, manages audit programs, strengthens internal controls, and collaborates with finance and legal teams.

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 and perform complex financial audits and reviews, evaluate compliance with federal and contractual requirements, develop corrective action plans, train staff, serve as subject matter expert for audit policies, recommend billing rates, and manage contract administration activities with stakeholders.

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.

Lead Trade-facing clinical and contract activities for manufacturer rebate programs. Advise Client Relations and Participants on PBM/UM policy, interpret manufacturer contracts, manage medical and pharmacy clinical policies for compliance, and collaborate cross-functionally to drive rebate program execution and clinical decision-making.

Lead and oversee an enterprise anti-fraud program using advanced data analytics to detect, investigate, and mitigate fraud, waste, and abuse. Manage investigations, establish policies and standards, implement analytic models and dashboards, liaise with internal and external partners, and lead a team to ensure timely, documented outcomes, training, and continuous improvement.

Provide paralegal support for brand and trademark matters: conduct clearance searches, prepare and prosecute domestic and international trademark filings, manage USPTO correspondence and outside counsel, investigate and help resolve trademark and domain disputes, maintain docketing and deadlines, research trademark law, respond to client inquiries, and assist with related legal and regulatory projects.

Lead and deliver end-to-end corporate strategy projects: scope work, manage teams, build stakeholder relationships, present findings to senior leaders, mentor junior staff, and ensure project outcomes align with executive 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.

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.

The Director of Payment Integrity leads payment integrity strategy for BCBSA, ensuring competitive capabilities across commercial and government markets, advising on program requirements, and managing complex initiatives with a focus on performance monitoring and continuous improvement.

Provide legal advice on commercial contracting, healthcare regulatory compliance, privacy, and licenses. Draft and negotiate complex contracts (including pharmaceutical rebate and pharmacy agreements), support compliance and privacy programs, monitor regulatory changes, assist with audits, disputes, trainings, and regulatory responses, and partner with cross-functional teams to mitigate legal risk.

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.

The Privacy Lead Consultant ensures BCBSA's compliance with privacy regulations, builds privacy programs, conducts assessments, and supports incident response across the enterprise.