Jobs at Blue Cross & Blue Shield of Mississippi

Reviews medical records, claims, analytical findings, complaints, referrals, and appeals for inappropriate care, utilization, billing, and potential fraud, waste, and abuse. Applies clinical guidelines, provider contracts, benefit plans, medical policies, and coding standards. Consults with medical and legal teams, recommends corrective interventions, and prepares objective, evidence-based audit reports and conclusions.

The Senior Systems Analyst analyzes business requirements, creates technical specifications, develops mainframe applications, and maintains claims applications while providing expert consultative support.

The Marketing & Development Manager drives sales, partners with agents for training and marketing, and ensures retention goals are met.

Analyze healthcare costs, risk, pricing, and forecasting by gathering, cleaning and analyzing data, updating actuarial models, and preparing financial and enrollment reports to support corporate decision-making.

Plan, install, configure, document and maintain network infrastructure (routers, switches, load balancers, firewalls). Ensure high availability/security, support business recovery tests, troubleshoot with vendors and internal teams, and monitor network performance and security.

The Senior Actuarial Analyst develops pricing models, analyzes claim trends, prepares financial statements, and updates financial forecasts.

The Chief Actuary develops pricing models, monitors trends, oversees financial reporting, and supports corporate initiatives, requiring extensive experience in health actuarial roles.

Implement and maintain provider reimbursement updates, including fee schedules, facility rates, pricing rules, and claims testing. Serve as the subject-matter expert for network reimbursement within the medical claims processing system and act as a technical consultant for reimbursement inquiries. Develop and execute test plans and ensure accurate documentation and communication across projects.

Manage and maintain provider contracting documentation, network provider directories, and contract templates. Validate provider contract completeness, update provider profiles and location changes, publish GeoAccess and SAS reports, coordinate contract changes and mail-outs, perform credentialing for Disease Specific Pharmacy providers, and back up Provider Service Specialist for provider inquiries.

Process and review medical claims accurately and timely using policy guidelines; research correspondence and communicate to resolve claim issues; meet established timeliness and accuracy benchmarks while supporting continuous development and potential career growth within the company.

Support corporate compliance by developing and maintaining policies, administering the HIPAA Privacy Program and Privacy Office, managing the Code of Conduct and hotline, administering Ethidex software, performing OFAC/exclusion monitoring, conducting compliance reviews, providing training, and supporting vendor contracting compliance.

Develop and enhance on‑site web applications to integrate BCBSMS business systems, prevent technical disruptions, and perform systems and business function analysis. Build/consume REST services, use source control, and follow full development lifecycle processes.

Develops and manages maternal and women's health quality programs, partners with providers and hospitals, analyzes clinical data, documents best-practice guidelines and technical measure specifications, presents performance data to providers, and aligns initiatives with value-based reimbursement models to improve patient outcomes.

Coordinate hospital quality improvement by reviewing KPIs, designing and leading evidence-based projects, ensuring regulatory and accreditation compliance, conducting audits, developing corrective actions, and presenting actionable data to improve provider performance and patient outcomes.