Jobs at Blue Cross NC

Lead configuration and administration of the Facets packaged system, act as SME for plan/product setup and business rules, develop modification and interface requirements, validate data with SQL, support SDLC activities, liaise with business stakeholders, and mentor junior staff.

Lead stakeholder communications strategy for providers, regulators, brokers, agents, consultants, and employer groups. Translate complex business decisions into clear external messaging, build trust, anticipate risks, align with Legal/Compliance/Government Affairs, modernize channels and processes, and influence cross-functional teams to execute enterprise narratives supporting affordability and credibility.

Lead clinical and non-clinical onboarding, deliver and design training based on audit-driven needs, perform clinical quality audits, maintain training resources, support system testing and digital process automation, and act as a day-to-day clinical resource for staff.

Provide high-level administrative support to leaders and teams by managing calendars, correspondence, meetings, travel and expense reporting. Coordinate departmental projects, events, moves, IT liaison work, and budget support. Prepare reports, analyze information for decision-making, maintain distribution lists and documentation, and exercise independent judgment on priorities.

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 end-to-end management of multiple large, enterprise programs: strategy, design, implementation, evaluation, budget and vendor/contract management, performance metrics, risk mitigation, and cross-functional coordination to meet program goals.

Designs and implements technical solutions and automations for business needs using reporting and database tools. Leads small-to-medium projects, analyzes requirements, develops and tests code, documents processes, trains end users, provides post-implementation support, and coordinates with business partners to ensure deliverables meet specifications and SLAs.

Support pharmacy actuarial work by performing actuarial calculations, pricing, reserving, forecasting, rate studies, data validation, model enhancements, reporting, and trend analysis. Collaborate with cross-functional teams and participate in the Actuarial Development Program while progressing toward the ASA designation.

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.

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.

Design and deliver enterprise learning solutions that close workforce performance gaps. Lead analysis, curriculum and blended learning design, measurement (Kirkpatrick levels 1-4), change management, and project delivery across large-scale, cross-functional transformation programs. Consult with business and clinical leaders to define objectives, time-to-proficiency, and evaluation methods, and produce multimedia and learning-adjacent collateral to drive adoption and outcomes.

Lead enterprise communications strategy to shape narratives, manage reputation and risk, align cross‑divisional stakeholders, and deliver high‑quality, timely communications. Advise senior leaders, manage crisis communications in healthcare/regulatory settings, oversee agency relationships and budgets, mentor teams, and drive operational excellence in messaging and stakeholder preparation.

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.

Senior Facets Developer designs, develops, enhances, and supports enterprise applications for health plan operations. Provides deep expertise in Facets and EAM, delivers high-availability, scalable solutions, troubleshoots production issues, performs analysis and design, writes testable code, partners with stakeholders and architects, and mentors junior team members to improve operational efficiency and member experience.

Evaluate and audit clinical staff/provider performance, ensure regulatory and policy compliance, provide feedback and learning solutions, support quality improvement, and drive data-informed clinical decision-making.

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.

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 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.