Jobs at Blue Cross NC

Principal Learning Solutions Architect serves as a strategic advisor to senior leaders, diagnosing workforce performance gaps and designing enterprise learning and non-learning solutions. Responsibilities include performance consulting, learning architecture, data analysis, executive communication, stakeholder influence, project leadership, and innovation involving digital learning, knowledge management, coaching, change adoption, communications, and AI-enabled learning technologies.

Conducts non-clinical utilization management reviews, communicates determinations to providers and members, documents outcomes, gathers required information, verifies authorization accuracy, supports CMS notification requirements, and refers clinically complex cases to nurses or Medical Directors. Also provides administrative support and serves as a subject matter expert on non-clinical review processes.

Conducts non-clinical utilization management reviews, communicates decisions to providers and members, documents outcomes, obtains required information, verifies authorization accuracy, and refers clinical matters to nurses or Medical Directors. Supports CMS notification requirements, administrative processing, and care management outreach while serving as a subject matter expert on non-clinical review procedures.

Provides strategic business and operational leadership for Medicare Advantage and Medicare Supplement lines of business. Responsibilities include business planning, performance and budget analysis, reporting, project leadership, change management, stakeholder partnerships, vendor coordination, and executive communications. The role monitors Medicare value levers such as Risk Adjustment, Star Ratings, CAHPS, provider performance, network effectiveness, membership growth, and operational efficiency while developing actionable recommendations for leadership.

Coordinates care, resources, and services for selected member populations. Conducts comprehensive assessments, develops individualized care plans, monitors progress, facilitates services across care settings, evaluates medical necessity, educates members, documents outcomes, and collaborates with healthcare teams, providers, families, and community resources.

Coordinates care, resources, and services for member populations across the healthcare continuum. Conducts assessments, develops individualized care plans, monitors progress, facilitates referrals and transitions, evaluates service appropriateness, educates members, documents outcomes, and supports high-risk or high-utilization cases. The role requires an RN with clinical or case management experience and applicable North Carolina or compact multistate licensure.

Provides enterprise-level business consulting and change leadership, connecting business strategy with capabilities, people, processes, technology, and information. Advises senior leaders on complex problems, facilitates strategic planning workshops, develops business architecture models and roadmaps, analyzes current and future states, and recommends improvements based on industry and environmental trends.

Designs and develops user-friendly dashboards, visualizations, reports, and analytic solutions. Collaborates with business stakeholders, data engineers, and data scientists to deliver actionable insights. Responsibilities include SQL-based data extraction, data quality controls, visualization governance, analytics tool administration, reporting, user support, privacy review for PHI, and communicating findings through presentations.

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.

Manages treasury operations, cash management, daily account funding, liquidity investments, cash-flow forecasting, banking relationships, and bank service negotiations. Oversees Treasury Analysts, develops cash management policies and controls, supports treasury-related projects, and ensures compliance, business continuity, and process documentation. The role also monitors banking and insurance regulations and identifies opportunities to improve liquidity and payment efficiency.

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.

Leads the enterprise risk management framework, including risk identification, assessment, monitoring, reporting, risk appetite governance, ORSA, stress testing, regulatory trend analysis, insurance and captive programs, and risk culture development. Partners with executive leaders, business units, governance committees, and the Board to integrate risk considerations into strategic planning, operations, and capital decisions.

Leads the analysis, design, development, testing, and support of complex healthcare payer software across on-premise and cloud environments. Serves as a TriZetto Facets subject matter expert, develops high-performance applications, resolves technical issues, evaluates buy-versus-build options, leads projects, mentors team members, and applies modern development practices and AI-assisted tools to improve efficiency.

Leads enterprise systems analysis and functional design for complex healthcare payer solutions. Elicits, prioritizes, and documents requirements; manages business rules, data mapping, traceability, risks, scope, and system impacts. Partners with business and technology teams to design, deploy, and maintain solutions, while advising stakeholders, coordinating teams, reviewing deliverables, supporting phased implementations, and mentoring analysts. Requires expertise in TriZetto Facets enrollment, billing, or claims, payer enrollment systems, and process automation.

Develops and implements specialty pharmacy network strategies, contracting approaches, reimbursement models, and affordability initiatives. Analyzes market, regulatory, provider, PBM, and technology trends; evaluates network performance and cost-reduction opportunities; builds financial business cases; and presents strategic recommendations to senior leadership. Collaborates with pharmacies, PBMs, vendors, consultants, providers, and enterprise stakeholders to optimize access, pricing, reimbursement, compliance, and sustainable specialty pharmacy affordability.

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.

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.

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 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.