Jobs at Blue Cross NC

Leads health plan operations across enrollment, membership, claims, customer service, fulfillment, and system support. Oversees operational performance, vendor relationships, quality assurance, KPIs, staffing, budgets, inventory, and service guarantees. Drives process standardization, automation, Lean Six Sigma improvements, and member-centric service delivery. Partners with Sales, implementation, configuration, service, and enterprise teams to resolve escalations, improve efficiency, and deliver strategic initiatives.

Lead elicitation, prioritization, and translation of business requirements into system-level functional designs for an external employer web portal. Produce functional specifications, GUI/VUI designs, conduct gap analysis, ensure traceability, and coordinate with developers, designers, and SMEs to deliver tested, phased solutions.

Leads Strategic Client Consultants responsible for retaining and growing profitable national-account business. Develops team talent, establishes client and broker relationships, drives consultative cross-selling, and develops segment-specific sales and retention strategies. Represents market needs internally, provides market intelligence, supports negotiations and compliance, and monitors team KPIs and sales goals. Requires 15%–20% travel and North Carolina Health and Life licensure within 90 days.

Lead development and improvement of short-, medium-, and long-term cash flow forecasts. Analyze cash trends and drivers, communicate insights to senior leadership and the board, partner with finance, actuarial, investments, and treasury operations, and optimize excess cash per investment policy to support capital allocation and operational planning.

Designs and engineers complex physical and cloud-hosted data center infrastructures spanning network, compute, storage, platform, middleware, databases, and telephony. Responsibilities include capacity planning, technical standards, infrastructure automation, performance analysis, incident resolution, technology roadmaps, vendor collaboration, licensing, and operational readiness. Provides subject-matter expertise, leadership consultation, and guidance to less experienced engineers while supporting large-scale infrastructure projects.

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.

Administers member and group enrollment, renewals, eligibility, billing, and membership records for health plan products. Resolves enrollment and billing discrepancies, maintains data integrity across multiple systems, applies regulatory requirements, processes error reports, and supports members, agents, and benefits administrators through telephone and written communications.

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.

Manage NCQA Health Plan Accreditation focused on Member Experience and Credentialing. Lead planning, documentation, readiness reviews, surveys, gap analysis, remediation, vendor oversight, cross-functional coordination, metrics tracking, and continuous improvement to ensure accredited compliance.

Leads multiple enterprise-scale projects and initiatives from planning through implementation. Manages cross-functional teams, resources, budgets, risks, compliance, vendors, business processes, and stakeholder communications. Tracks milestones, evaluates outcomes, develops mitigation plans, and drives process improvements. Coaches team members and supports strategic business objectives through analysis, reporting, and executive communication.

Leads client relationship management and account strategy for group health and ancillary insurance products. Responsibilities include retaining and growing revenue, partnering with brokers and sales representatives, managing renewals, presenting benefit proposals, analyzing financial and utilization reports, supporting implementation and enrollment, and educating employees. The role requires strong knowledge of benefits administration, insurance products, pricing, negotiations, and client consulting.

Develops market and competitive intelligence, analyzes complex healthcare, financial, operational, payer, and market data, and translates findings into executive-ready strategic recommendations. Supports near- and mid-term strategy for care delivery assets, alliance management, investment analysis, business cases, scenario planning, and implementation-ready roadmaps. Partners across strategy, corporate development, legal, compliance, and communications teams to advance care delivery growth and innovation.

Leads clinical pharmacy strategy for a large employer client, advising on formulary design, utilization management, specialty pharmacy, clinical programs, rebates, and pharmacy operations. Partners with internal and client stakeholders to optimize outcomes, member experience, affordability, and total cost of care. Evaluates pharmacy trends, financial and clinical performance, regulatory requirements, and emerging therapies. Leads client meetings, executive presentations, strategic planning, and implementation of pharmacy benefit initiatives.

Build and maintain Workday reports, dashboards, discovery boards, and workforce data solutions. Translate HR and business needs into actionable insights, consult with HR stakeholders, analyze workforce trends, troubleshoot reporting issues, maintain data accuracy, and promote self-service reporting. Partner with HR Technology on reporting standards, security considerations, dashboard adoption, and continuous improvement.

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 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.

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 an FP&A team partnering with divisional leaders to deliver budgeting, forecasting, reporting, cost analysis, and operational-to-financial integration to support strategic decision-making and resource stewardship.

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.

Serve as analytics partner to SIU and Payment Integrity teams to develop dashboards, financial and operational reports, analyze healthcare claims, design statistically valid sampling for audits, support investigations and recoveries, improve data quality, and communicate insights to leadership to drive savings and efficiency.