Jobs at Blue Cross NC

Support actuarial teams with rating, pricing, valuation, and forecasting for health programs. Perform data retrieval/validation, experience studies, statistical analyses, ALR/UCL calculations, rate filings, and reporting. Collaborate with underwriting, network, finance, and other stakeholders and participate in the Actuarial Development Program.

Lead advanced actuarial modeling, pricing, valuation, and financial forecasting for health insurance products. Support rate development, rate filings, medical trend and experience studies, underwriting, network management, and product development. Provide consultative expertise and occasional project leadership while maintaining actuarial credentials and continuing education.

Lead the People Insights function to deliver workforce analytics, reporting, dashboards, and insights. Manage intake, prioritization, resource planning, and service delivery. Partner with HR, Finance, and business leaders to provide data-driven recommendations. Coach and develop a team, ensure governance, data quality, security, and continuous improvement of Workday analytics.

Lead and deliver complex data science and engineering projects: design data models and scalable pipelines, build and productionize statistical and ML models (Python/R), perform data integration and quality work, generate actionable insights for executive stakeholders, and provide domain leadership in Payment Integrity/FWA.

Lead underwriting and strategic pricing for Commercial Employer markets, driving profitable membership growth through risk assessment, rate development, forecasting, and modernization. Partner with Actuarial, Finance, Sales, Product, and Operations to set governance, pricing methodologies, and performance standards, while building a high-performing underwriting organization and providing strategic leadership for Stop Loss and national business.

Lead enterprise payment integrity strategy to prevent, identify, and recover inaccurate healthcare payments. Drive reimbursement policy, claims editing, coding validation, analytics, automation, vendor management, provider engagement, and governance to improve payment accuracy, reduce waste, and achieve cost-savings targets while partnering across finance, clinical, legal, and technology functions.

Lead pre-sale and post-sale implementation for non-standard and custom groups, design and manage project plans, resolve complex implementation issues, coordinate benefits and eligibility workstreams, manage cross-functional stakeholders, and ensure timely, high-quality account installations for large or high-profile clients.

Serve as liaison between Enrollment Operations, IT and vendors to support 834 electronic enrollment transactions, troubleshoot production issues, perform root-cause analysis, document and improve processes, configure systems, coordinate business testing, and drive automation and reporting to improve enrollment accuracy and operational performance.

Coordinate care and resources for Medicare members, perform comprehensive assessments, develop and monitor individualized care plans, facilitate transitions across care settings, document interventions and outcomes, and collaborate with members, families, providers, and community resources to optimize clinical and resource outcomes.

Manage pharmacy utilization management operations and clinical review teams for a business segment. Drive operational and quality targets, oversee vendors and compliance, develop strategy, represent Pharmacy in cross-functional initiatives, support budget and technology roadmaps, and provide clinical consultation on medication therapy and UM programs.

Manage strategic provider engagement and network initiatives for Blue Cross NC Medicare Advantage products. Build and maintain provider partnerships, ensure contractual compliance, analyze financial/reimbursement impacts, reduce administrative burden, deliver provider education and workshops, resolve complex operational issues, support new payment models and emerging care solutions, and collaborate cross-functionally to improve provider satisfaction and network performance.

Provide strategic employment law counsel on hiring, performance management, terminations, benefits, wage-and-hour and regulatory compliance; draft policies; oversee employment litigation and EEOC matters; support corporate transactions and due diligence; select and manage outside counsel; advise senior leadership; mentor legal team and deliver training.

Serve as primary county contact for a cohort of NC counties, build and execute community-focused initiatives, manage programs and policies, collaborate with internal teams, train entry-level staff, and spend ~80% of time engaging locally to support Medicaid, Medicare, and Federal Employees Program goals.

Support IT risk management and controls, perform third-party/vendor risk assessments, assist IT audits and SOX support, develop metrics and dashboards, deliver training, and monitor remediation to reduce exposure and ensure compliance.

Lead and deliver complex technical initiatives end-to-end: coordinate stakeholders, manage risks, dependencies, resources, and budgets, mentor team members, and ensure timely approved deliverables across multiple concurrent projects.

Lead complex actuarial projects focused on ACA risk adjustment, pricing, forecasting, and competitive benchmarking. Provide strategic actuarial guidance, manage vendor and regulator relationships, achieve financial targets, and communicate results to senior leadership while maintaining actuarial credentials.

Serve as a strategic finance leader partnering with senior leadership to drive financial strategy, multi-year planning, and operational cost optimization. Lead complex financial analyses, develop financial models and executive presentations, identify operational improvements, and oversee implementation to realize value. Influence cross-functional initiatives and provide thought leadership across divisional and enterprise planning.

Support IT risk management and controls by identifying and assessing IT/security risks, assisting remediation and monitoring plans, supporting audits, documenting controls and processes, and providing training and advisory support to business owners and project teams.

Lead end-to-end customer and employee experience initiatives using Lean Six Sigma and human-centered design. Consult senior leaders, manage complex process transformation projects, define standards and guardrails, conduct current-state analysis, measure outcomes, maintain documentation and control plans, coach teams, and ensure regulatory compliance across channels and segments.

Lead development and maintenance of actuarial data marts, extracts, reports, validations and audits. Drive requirements, technical specs, automations, and financial analyses; mentor staff and coordinate with vendors and business partners to ensure accurate, auditable financial data.