Jobs at BSC Industries, Inc.

Design and deliver end-to-end full stack healthcare applications across UI, API, and data layers. Build secure, testable, cloud-native services, implement integrations and IaC, support CI/CD and monitoring, leverage AI-assisted tools, and mentor engineers while partnering with cross-functional teams.

Leads formulary implementation and maintenance across Commercial, Exchange, and Medicare lines of business. Maintains drug databases, utilization management edits, procedures, reports, and regulatory documentation. Coordinates with internal departments and external pharmacy benefit vendors, validates claims, supports CMS submissions, develops formulary materials, and ensures configuration and operational workflows comply with business rules, audits, and state and federal regulations.

Leads formulary implementation and maintenance across Commercial, Exchange, and Medicare lines of business. Maintains formulary databases, utilization management edits, procedures, reports, and regulatory documentation. Coordinates with pharmacy claims adjudicators, vendors, analytics, benefits, compliance, communications, and other stakeholders. Validates claims, identifies system and workflow issues, supports CMS and state submissions, develops formulary materials, and ensures implementation complies with business rules and regulatory requirements.

Processes and reconciles individual and group health plan enrollment, eligibility, cancellations, changes, and rates. Verifies data against source documents, investigates discrepancies, obtains missing information, and coordinates with internal, external, and vendor stakeholders. Makes routine and complex processing decisions while maintaining accurate membership records and communicating effectively with business partners.

Leads complex financial, operational, and integrated audits and advisory engagements. Assesses internal control design and effectiveness, performs risk assessments, develops audit findings and recommendations, presents results to management, and follows up on corrective actions. Manages strategic cross-functional initiatives and may lead other contributors. Applies advanced data analytics, AI-enabled tools, automation, continuous monitoring, and automated control testing to identify risks, anomalies, and control gaps while promoting responsible technology adoption in audit processes.

Leads complex product implementation programs from intake through resolution, including requirements gathering, business cases, governance, prioritization, resourcing, risk mitigation, stakeholder coordination, and issue resolution. Advises Product leadership, coaches project managers, documents processes and solutions, reports program status, and improves operational workflows and standards across multiple business areas.

Design, develop, and enhance Oracle Fusion Financials solutions (GL, AP, Cash), build integrations (REST/SOAP, FBDI, OIC), troubleshoot production issues, support financial close processes, migrate or cross-train to Workday, document solutions, and mentor junior staff.

Lead design and delivery of scalable, secure full‑stack features and services. Build maintainable front-end and backend code, implement integrations and data models, enable cloud-native CI/CD workflows, use containers and IaC, and act as a technical leader influencing architecture and delivery across teams while leveraging AI-assisted tools.

Leads provider network operations for health plans, overseeing contracting operations, compliance, governance, provider relations, and cost-of-care strategies. Develops strategic roadmaps, evaluates contract performance using analytical frameworks, mitigates network and contractual risks, and drives cross-functional initiatives involving finance, actuarial, clinical, and operations teams. The role also manages policies, procedures, system enhancements, stakeholder communications, and high-performing teams.

Manage the full lifecycle of macOS workstations and iOS/Android mobile devices using JAMF and Microsoft Intune. Responsibilities include device enrollment, configuration, software deployment, patching, application enablement, security and SSO controls, third-level support, incident response, audit and disaster recovery participation, remediation, architecture and project engagement, and maintaining platform standards and documentation.

Build and maintain relationships with California provider networks, support contract compliance, resolve escalated claims and operational issues, deliver provider education and strategic communications, and improve network performance. Analyze data and coordinate reports related to provider rates, accessibility, availability, member experience, out-of-network utilization, and regulatory goals. Lead provider meetings and regional strategies while achieving quantifiable network performance targets.

Performs month-end close activities, including journal entries, account reconciliations, accruals, balance-sheet fluctuation analysis, and financial reporting. Researches and resolves complex accounting discrepancies, supports audits, collaborates with IT and internal departments on system and data issues, and contributes to accounting requirements for new products and system implementations. Maintains accounting procedures and provides schedules, analyses, and ad hoc project support to management.

Supports healthcare commercial compliance oversight by validating regulatory mandate implementation, reviewing compliance artifacts, conducting audits, identifying execution gaps, recommending corrective actions, and preparing analyses for senior leadership. Advises cross-functional stakeholders on regulatory changes, researches complex compliance matters, and helps improve compliance processes, tools, reporting, governance, and audit readiness.

Oversee compliance with HIPAA, HITECH, CMIA, TCPA, and other privacy requirements. Lead privacy investigations, root-cause analysis, mitigation, corrective actions, and case documentation. Provide privacy guidance on projects, respond to inquiries, develop training and policies, support regulatory audits and reviews, and evaluate disclosures or third-party access to protected health information.

Leads enterprise growth strategy governance, strategic planning, portfolio prioritization, and performance management across markets and business units. Facilitates executive governance forums, develops roadmaps and operating plans, tracks risks and outcomes, coordinates cross-functional initiatives, builds business cases, and prepares executive- and board-level materials. Requires strong healthcare growth strategy experience, executive communication skills, and the ability to drive alignment and accountability across senior leaders.

Build and maintain relationships with California provider networks, improve provider performance, support contract compliance, resolve escalated claim disputes, and conduct data-driven operations meetings. The role coordinates provider education, strategic communications, regulatory accessibility initiatives, performance metrics, and rate-increase analysis while driving network goals, reducing out-of-network utilization, and improving member access and experience.

Leads enterprise FP&A data governance, forecasting, financial modeling, expense allocations, and consolidated reporting. Develops dashboards, variance analyses, performance reports, and strategic decision support for executives and the Board. Enhances planning systems, reporting automation, controls, and data quality while ensuring compliance with GAAP and company policies. Presents complex financial insights and drives process improvements across stakeholders.

Develop and maintain custom employer health plan designs and member documents for RFPs, renewals, and implementations. Apply knowledge of healthcare products, benefits, regulations, and mandates while collaborating with Sales and cross-functional stakeholders. Analyze and test web-based system requirements, support workflow improvements and change management, track quality and progress, coordinate peer processes, and guide continuous improvement for medium-complexity custom and self-funded products.

Handles member appeals, grievances, complaints, and reconsiderations by receiving calls, researching cases, explaining health plan policies, assigning or rerouting issues, documenting outcomes, and responding within compliance deadlines. The role also tracks and trends grievances, manages a caseload, collaborates with internal teams, and supports multiple health plan lines of business. Occasional unplanned overtime or Saturday work may be required.

Leads an engineering team delivering secure, scalable, reliable technology solutions. Oversees planning through release, staffing, performance management, technical decision-making, risk resolution, stakeholder alignment, and delivery health. Partners with Product, Architecture, Security, Platform, QA, vendors, and business teams. Promotes cloud-native development, CI/CD, automation, testing, observability, maintainability, secure practices, and continuous improvement while fostering accountability, collaboration, communication, and team growth.