Jobs at Blue Cross of Idaho

Leads data-driven quality assurance improvements by analyzing workflows, identifying risks and inefficiencies, and implementing automation, AI, reporting, and technology-enabled solutions. Develops process documentation, business requirements, implementation plans, and performance monitoring approaches. Partners with quality, compliance, operations, data, and technology teams on cross-functional initiatives from concept through adoption, supporting audit readiness, continuous improvement, and scalable operational excellence.

Drive new sales and membership growth across Idaho by developing strategic relationships with brokers, consultants, employer groups, and executive stakeholders. Lead complex sales cycles, including prospecting, RFPs, presentations, negotiations, and implementation coordination. Create strategic account plans, analyze market and performance data, collaborate with internal partners, deliver consultative solutions, maintain sales forecasts, and strengthen long-term client partnerships.

Analyzes, manages, and implements payment integrity editing and auditing programs. Monitors trends, identifies process improvements, collaborates with internal and external stakeholders, develops functional requirements with software developers, reviews contracts and policy language, and prepares technical assessments to ensure claims processing aligns with organizational requirements.

Plans and delivers enterprise projects by defining objectives, scope, requirements, schedules, budgets, resources, risks, and success criteria. Coordinates cross-functional business and technology teams through solution delivery, testing, user acceptance, and implementation. Establishes communication and reporting mechanisms, manages dependencies and quality, supports continuous improvement, and promotes effective project management and hybrid delivery practices.

Manages supplier contracting, negotiations, strategic sourcing, competitive bidding, and contract lifecycles. Drafts and negotiates agreements, statements of work, amendments, pricing, service levels, and risk protections. Partners with business owners, Legal, Compliance, Privacy, Cybersecurity, Risk, Finance, and other stakeholders to evaluate suppliers, mitigate contractual risks, improve value, reduce costs, and strengthen procurement processes and supplier relationships.

Leads the enterprise tax function across affiliated entities, overseeing federal and state compliance, tax accounting and provisions, strategic planning, governance, controls, audits, and external advisors. Partners with Finance, Legal, Treasury, Investments, and business leaders on tax implications of transactions, restructuring, capital planning, and growth initiatives. The role also researches technical tax matters, improves tax processes, and develops internal accounting team capabilities.

Owns the strategy, roadmap, backlog, requirements, and delivery of technical healthcare products. Translates business, clinical, regulatory, and technical needs into user stories and acceptance criteria while guiding Agile teams. Partners with architects, engineers, operations, compliance, and leadership on integrations, cloud transformation, AI, automation, interoperability, and digital health initiatives. Ensures products meet healthcare regulations, technical standards, and measurable business outcomes.

Reviews insurance claims to determine approval, denial, or need for further investigation. Applies business rules, policies, and contracts; identifies and escalates issues; and audits existing claims for errors and omissions.

Develops and executes strategic plans for complex healthcare accounts, driving retention, growth, cross-selling, and long-term partnerships. Builds executive relationships, leads consultative benefit discussions, coordinates cross-functional teams, analyzes market and account data, identifies strategic opportunities, and communicates performance, risks, and recommendations to senior leadership. Requires extensive enterprise account management experience, healthcare industry knowledge, underwriting familiarity, and strategic selling capabilities.

The AI Technical Lead designs and delivers scalable AI systems, providing technical leadership, mentoring teams, and ensuring effective deployment of machine learning solutions across the organization.

Lead the design and implementation of a multi-tenant enterprise data architecture on AWS and Snowflake. Oversee data engineering standards, mentor teams, and ensure efficient data management and integration for business needs.

Designs, develops, maintains, and troubleshoots software systems and infrastructure with emphasis on automation, CI/CD, testing, and operational monitoring. Builds automation tools and scripts, supports deployments, mentors engineers, and follows Agile/SAFe practices.

The VP, Claims & Payment Integrity Operations oversees enterprise strategy and operations for claims and payment integrity, ensuring compliance while driving improvements in accuracy and financial outcomes.