Jobs at Blue Cross NC

Manages major-market client relationships for health insurance groups, focusing on retention, renewals, profitability, revenue growth, and ancillary product sales. Analyzes client financial, utilization, and market data to recommend benefits solutions, negotiates renewals, supports enrollment and service delivery, and develops trusted relationships with producers and business leaders. The role also monitors competitors, identifies best practices, and contributes to process improvements and community engagement.

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.

Leads complex technical projects and programs from planning through delivery, coordinating business and technology partners, managing schedules, deliverables, resources, scope, and budgets. The role may oversee multiple concurrent initiatives in a matrixed environment and mentor team members. Candidates need a bachelor’s or advanced degree, or equivalent experience, and at least five years of related experience. The position follows a hybrid-flex work model and does not offer employment authorization sponsorship.

Leads organizational development and effectiveness strategies across a complex healthcare enterprise. Advises executives, diagnoses organizational and workforce challenges, designs culture and change interventions, advances team and leadership effectiveness, and aligns operating models, governance, talent, and performance. Uses qualitative and quantitative insights to define impact measures, guide culture action plans, and improve employee engagement and organizational performance. Partners with HR Centers of Excellence and business leaders to drive enterprise transformations and sustainable organizational adaptability.

Provides advanced analytical support for ACA risk adjustment, including model implementation, RAF validation, forecasting, reporting, reconciliation, and discrepancy analysis. Uses SQL and Python to analyze healthcare data, improve recurring processes, develop controls, and support regulatory and financial activities. Partners with actuarial, regulatory, finance, operational, provider, and vendor stakeholders; presents findings and recommendations; maintains analytical applications; and mentors less experienced employees.

Leads enterprise data visualization strategy, architecture, governance, and development standards. Designs scalable Tableau-based analytics solutions, analyzes complex business problems, supports project delivery, and provides technical guidance to visualization users. Mentors junior staff, facilitates cross-functional problem solving, and advises leadership on data visualization decisions. Requires healthcare claims processing and Facets expertise, CMS Guidelines knowledge, and familiarity with fraud, waste, and abuse trends.

Owns and prioritizes the team sprint backlog, aligning work with business objectives, customer needs, and product roadmap commitments. Collaborates with product managers, stakeholders, and delivery teams to define and decompose user stories, communicate product vision, and represent stakeholder expectations. Requires business knowledge of the assigned healthcare area and supports streamlined execution of product priorities.

Provides business and operational support through strategic and workforce planning, project coordination, budget and KPI analysis, reporting, process improvement, change management, leadership communications, event planning, and vendor relationship management. Supports executive and board communications, evaluates efficiency opportunities, coordinates external engagements, and tracks departmental initiatives and staffing against strategic goals.

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.

Leads financial strategy, planning, analysis, and reporting for assigned business divisions. Partners with leadership and cross-functional stakeholders to develop financial plans, evaluate business opportunities, quantify impacts, maximize ROI, and drive financially significant initiatives. Provides actionable insights, supports long-term planning, represents divisional financial positions, and helps implement solutions to emerging business issues.

Lead short-, medium-, and long-term cash flow forecasting; analyze liquidity trends, risks, and opportunities; communicate actionable insights to senior management and the Board; partner with Finance, Treasury, Actuarial, Investments, and business leaders; and optimize excess cash according to investment policies.

Provides audit and risk advisory services across subsidiaries, focusing on financial, strategic, and entity-level risks and controls. Performs walkthroughs, control testing, process analysis, audits, deficiency assessments, remediation validation, and advisory engagements. Uses COSO and related frameworks to strengthen governance and internal controls, develops mitigation strategies, documents findings, trains management, and prepares audit reports.

Leads financial analysis, annual and long-term planning, forecasting, ROI evaluation, and strategic financial initiatives for business divisions. Partners with leaders and cross-functional stakeholders to translate complex financial issues into actionable plans, recommendations, and measurable outcomes. Builds financial strategies, supports divisional decision-making, and drives financial stewardship and innovation.

Prepare and review financial statements, coordinate month-end close and reporting, analyze complex accounting information, resolve GAAP/SAP issues, maintain controls, support audits, and recommend process improvements. Provide technical guidance, coach colleagues, conduct due diligence, evaluate deal structures, and participate in cross-functional finance projects. The role requires collaboration with auditors, other Blue Cross plans, and the BCBSA.

Supports commercial reserving through actuarial research, experience studies, statistical analysis, premium and reserve calculations, valuation, rate filings, reporting, and healthcare analytics. The role validates data, enhances actuarial models, investigates trends, supports regulatory submissions and enterprise risk management, and provides analytical support to internal business partners. Candidates need a degree, actuarial experience, and at least three exams toward the ASA designation, with alternatives considered for additional experience or exams.

Leads enterprise solution and data architecture for complex business and technology initiatives. Defines architecture strategies, roadmaps, standards, and reference models; governs scalable data platforms, integrations, cloud solutions, APIs, security, and AI-enabled technologies. The role evaluates emerging technologies, manages technical risks, guides SDLC implementation, and mentors architects and engineering teams. It also communicates architectural recommendations and trade-offs to executive and technical stakeholders while aligning solutions with business goals, compliance, performance, scalability, and long-term technology strategy.

Provides legal counsel for pharmacy benefit management and State Health Plan operations. Responsibilities include interpreting PBM contracts, advising on state and federal health plan regulations, supporting vendor oversight, privacy and data governance, audits, public records requests, claims and appeals, regulatory inquiries, and implementation initiatives. The role also monitors legal developments, trains stakeholders, and helps manage contractual, compliance, and operational risks.

Leads strategic sourcing, category management, vendor governance, contract negotiations, supplier relationship management, risk assessments, and compliance for IT hardware, software, and services. Develops sourcing strategies, bid documents, evaluation criteria, vendor plans, performance metrics, and total-cost optimization recommendations. Partners with stakeholders, Legal, Compliance, Audit, Risk Management, and vendors to resolve contractual issues and improve procurement processes.

Own and govern the ServiceNow CMDB and Configuration Management System, ensuring accurate configuration items, relationships, discovery data, service mapping, and lifecycle processes. Lead CMDB upgrades and integrations across cloud, infrastructure, and container environments, including AWS, Kubernetes, OpenShift, and Tenable. Partner with IT teams and business owners, monitor data quality and platform performance, enforce ITIL processes, and provide reporting, audits, and continuous improvement recommendations.

Develops technical business solutions, automation tools, reports, and productivity improvements using applications such as SQL, VBA, Business Objects, and Tableau. Analyzes requirements, gathers business needs, tests and debugs code, coordinates projects, manages implementation plans, documents solutions, trains users, and provides post-implementation support. Acts as a technical lead and consultative partner across business areas while ensuring adherence to standards and service-level agreements.