Jobs at Blue Cross NC

Design and document conceptual, logical, and physical data models (relational, dimensional, NoSQL). Support data architecture and governance, produce DDL/SQL, design Snowflake Silver/Gold analytical layers, mentor other modelers, and map healthcare sources to FHIR resources when applicable.

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.

Lead a team managing financial systems, ensuring application security, administration, upgrades, and data governance. Oversee audits, compliance, training, performance reporting, requirements analysis, and cross-functional system projects to support financial reporting and process improvements.

Lead enterprise product development from ideation to market launch for TPA and care delivery offerings. Build business cases, partner cross-functionally, define pricing and go-to-market, manage stakeholder alignment, and drive strategic initiatives to evolve health solutions.

Design and deliver complex physical and cloud data center infrastructures (network, compute, storage, telephony, middleware, database). Lead capacity planning, lifecycle management, standards, and vendor partnerships. Provide expert support during incidents, produce engineering documentation, and mentor junior engineers.

Lead workforce planning execution through Workday and Adaptive tools: interpret hiring signals, track variance vs. plan, maintain position data, improve processes, partner with HR COEs, Finance, and People Analytics to deliver reports and insights for leaders.

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.

Lead Workday HR technology configuration and integrations, translate HR/Finance requirements into technical solutions, develop and maintain integrations (EIB, Studio, Core Connectors, APIs, RaaS), manage lifecycle and releases, troubleshoot and ensure data accuracy, mentor team members, document configurations, and partner with HR, Payroll, Finance and IT to align Workday capabilities with business strategy.

Support design, implementation, and integration of Workday technical infrastructure. Provide project technical support, assess technical needs, document costs/risks/feasibility, and ensure system stability and standards compliance.

Lead sourcing and vendor governance for IT categories (primarily hardware, also software and services). Develop sourcing strategies, run RFP/RFI/RFQ events, negotiate contracts, manage supplier relationships, track vendor performance and risk, and coordinate compliance with Legal, Audit, and Risk teams. Support stakeholders on vendor selection and implement vendor management plans and process improvements.

Lead design and engineering of complex physical and cloud data center network and telephony infrastructure. Drive requirements analysis, capacity planning, standards, vendor collaboration, project leadership, operational readiness, incident resolution, and mentorship to ensure scalable, performant network solutions.

Lead complex business analysis: elicit, document, and manage requirements; design process and system changes; drive business readiness, training, and reporting; conduct post-implementation audits; collaborate with technical teams and stakeholders; mentor junior analysts.

Prepare monthly financial reporting, perform variance and ad-hoc analyses, build models for forecasting and scenario planning, support budgeting and reforecasting, collaborate with cross-functional finance partners, and improve reporting processes to deliver accurate, decision-ready insights for leadership.

Lead statewide school-based and county DSS initiatives for the Children and Families Specialty Plan. Develop strategy, ensure compliance with educational protections for youth in foster care, establish outcomes and evaluation metrics, design programs addressing social-emotional and educational needs, collaborate with child welfare and education partners, manage a team and regional DSS liaisons, advise senior leadership, and oversee implementation, documentation, and staff development.

Lead definition, validation, and maintenance of HEDIS-related data pipelines and integrations. Develop SQL/Python/R programs, map claims-clinical-vendor-FHIR data, monitor monthly loads, reconcile vendor feeds, run trend analysis, support audits, and implement automated workflows to ensure data quality and regulatory compliance.

Serve as a senior finance partner delivering advanced financial modeling, cost allocation, budgeting, forecasting, and decision support. Build and maintain driver-based and scenario models, validate core financial datasets, design scalable dashboards and reports, automate analyses, and document methodologies. Provide actionable insights to leaders and lead process improvements across financial planning and reporting.

Lead design, development, and delivery of ML, DL, and Generative AI systems for production. Apply prescriptive analytics, optimization, recommendation, and reinforcement learning. Build and evaluate models, run experiments, develop prototypes, benchmark methods, and collaborate with business partners to translate data into actionable recommendations and influence strategy.

Support North Carolina Medicaid compliance by maintaining program documentation and SOPs, tracking audits and corrective action plans, coordinating projects, consolidating data and KPI reporting, and partnering with business units, legal, and vendors for regulatory engagements.

Lead complex actuarial pricing, valuation, and forecasting for ACA products. Develop and maintain rating models, perform medical trend and experience studies, support rate filings, underwriting, network management, provider contract evaluation, sales/marketing, and new product development. Serve as subject matter expert and advisor while maintaining actuarial credentials and continuing education.

Lead a team to develop and execute full-funnel digital acquisition and retention strategies across paid channels. Build measurement frameworks, run analytics and testing, optimize ROAS and lifetime value, aggregate channel reporting and attribution, and manage audience segmentation and campaign performance to meet member acquisition and retention goals.