BlueCross BlueShield of South Carolina

Software Engineer

• Daily responsibilities center on serving as a trusted contributor across both public and private cloud platforms, contributing to the design, build, integration, administration, and troubleshooting of cloud environments.
• Close collaboration with application teams, infrastructure partners, and business stakeholders to deliver scalable, resilient, and secure cloud solutions.
• Build, enhance, and maintain cloud‑native services using technologies such as AWS, OpenShift, Kubernetes, and Linux‑based platforms, applying strong technical judgment to resolve complex challenges while balancing security, performance, and operational excellence.
• Gather, refine, and translate business and technical requirements into actionable cloud solutions, leveraging emerging technologies and industry best practices to continuously improve platform capabilities and developer experience.
• Participate in a shared 24x7 on‑call rotation, with coverage rotating weekly across team members, demonstrating a high level of ownership, accountability, and a team‑first commitment to support.

Senior Systems Programmer Analyst

Sales

• Provide dedicated support for the Request for Proposal (RFP) process, including strategic input on sales strategy responses, coordination during peak seasons, and ensuring timely, high-quality submissions.
• Secure, track, and maintain client references and performance guarantees to build a robust library of social proof and market intelligence.
• Identify, analyze, and implement improvements to core sales processes.
• Focus areas include enhancing workflows with key partners and refining sales transition processes, including meticulous tracking and reporting.
• Conduct comparative analyses of performance guarantees across various markets, industries, and consultants.
• Track trends to help standardize and improve market-specific offerings and inform strategic decision-making.
• Assist in developing high-impact sales presentations, pitch decks, and supporting materials.
• Provide timely assistance with follow-up questions from prospects and clients, ensuring clarity and consistency in communication.
• Establishes and maintains positive Partner Plan distribution channel relations.
• Manages working relationship with Partner Plans including legal, policy and procedures and issue resolution.
• Gather and synthesize market and competitive intelligence to help the sales team better position our offerings.
• Monitors marketplace regularly to identify trends in sales, competitors, BlueCross BlueShield Association initiatives and product design.
• Sends/shares data to senior management and Partner Plans for review on a regular basis.

Sales Enablement Advisor

Learning and Development

• Responsible for identifying training needs, developing training materials and facilitating training.
• Provides training, guidance and leadership for new training specialists.
• Develops performance assessments and testing materials.
• Manages trainees and communicates effectively with area management on trainee performance.
• Leads, plans and prioritizes training projects from conducting training needs assessments to the delivery of the final product which meets customers specifications and due dates.
• Facilitates technical and non-technical training to employees, business partners, external customers, and other audiences.
• Gathers data from quality audits and team development surveys and incorporates in training deliveries.
• Tracks and monitors team interactions and provides feedback to trainees and their management.
• Identifies developmental needs and provides guidance, coaching and train-the-trainer sessions as needed.

Training Specialist II

Analyst

• Review claims and process refunds
• Research claims history for adjustments
• Update claims systems to complete refund process
• Adjust claims history to reflect refunded amounts
• Process transactions for purged claims
• Respond to inquiries from internal and external customers

Refund Analyst I

Project Manager

• Supports management in the administration of projects that may involve, but are not limited to, business change mandates, system enhancement, contract directives, analysis of operating procedures, quality control activities, strategic planning, performance monitoring, compliance activities, etc.
• Monitors the progress and status of area projects and coordinates the installation of each project phase.
• Prepares specialized reports and presentations for management or staff as it relates to the progress of new projects and initiatives.
• Writes and delivers instructions to staff when projects affect work assignments and departmental operations.
• Administers various projects and assists management in the overall functioning of the business area.
• Identifies procedural/system issues affected by implementation of project initiatives.
• Makes recommendations for change/development, both technically and operationally.
• Provides monitoring of key operating statistics.
• Follows up with all changes, improvements and processes to ensure compliance and effectiveness.
• Assists in the creation and implementation of work improvements and action plans for the department related to critical business processes and/or customer service-related requirements.
• Assists in the creation and implementation of plans and programs to assure staff is following all established and new processes/policies.
• Prepares written instructions, presentations, etc. and administers training for staff members.
• Provides effective feedback and develops work instructions and job aids to assist the staff in understanding any impact to daily job responsibilities.
• Responds to issues or concerns from internal/external support areas.
• Coordinates activities among division functional areas.
• Prepares and analyzes specialized reports for staff as it relates to the progress of new projects and initiatives.
• Maintains effective relationships with internal/external entities by leading and participating in meetings, conferences, workshops and professional organizations, ensuring necessary information is received/delivered to meet business unit objectives.

Project Administrator

Business Development Rep

• Manages all activities of proposal development
• Responsible for searching out, understanding, verbally articulating detailed analysis of RFPS, RFIS, RFQS, and other documents
• Collaborates with management, Subject Matter Experts (SME), and other staff to develop a high quality, winning proposal
• Establishes teams across organization to pursue/win new strategic opportunities
• Hires, manages, develops skilled staff
• Develops/maintains proposal schedule (review and production phases), plans, outlines, assignments, baselines, and storyboards
• Researches/analyzes historical data to support proposal efforts
• Develops process/work flows and oversees SME proposal contributions to add value/marketing statement
• Develops compilation of historical corporate data to provide easy access to resources for proposal library and database of information for other proposals as appropriate
• Assists with sales/retention goals and in identifying and qualifying new business opportunities/partnerships and implements strategies for winning new and keeping existing business to include developing sales and training materials
• Prepares/gives sales presentations to prospective customers
• Meets with select accounts to influence decisions specific to plan design and/or clinical programs in a manner beneficial to the company by conducting financial modeling, trend evaluation, and/or clinical analysis
• Develops relationships with current and future partner plans plus other strategic alliances (key internal corporate contacts) to leverage overall competencies to win new products/business
• Assists in program and project management as needed

Business Development Manager

• Responsible for analysis, design, programming, and implementation of the most complex applications tasks and projects in the area.
• Devise feasible, logical procedures to resolve business problems through the use of computer resources.
• Formulate scope and objectives through research to develop or modify complex systems.
• Provide technical direction and support in the development and support of business systems software and procedures.
• Design, code, test and debug the most complex application programs.
• Review and analyze systems, streamlining processes to ensure efficient, consistent use of all resources and adjusting designs to maximize reusability and reduce costs across subsystems.
• Provide technology solutions and prototypes to be used as the basis or template for more complicated business/technical requirements.
• Research, diagnose, and develop fixes for defects in existing code.
• Address maintenance issues related to current development, testing, and production.
• Act as an internal consultant, advocate, mentor, and change agent providing expertise and technical guidance on complex projects.
• Work closely with customers, business analysts, and team members to determine business requirements that drive the analysis and design of quality technical solutions.
• Ensure solutions are aligned with business and IT strategies and comply with the organization’s architectural standards.
• Provide design recommendations based on long-term IT organization strategy.
• Make recommendations towards the development of new code or reuse of existing code.
• Perform analysis, design, programming, and implementation on systems and procedures to solve complex business or scientific problems.
• Develop enterprise-level applications and custom integration solutions.
• Evaluate complex interrelationships in immediate programming area to determine how changes in one program will affect another related area.
• Develop programming and development standards.
• Devise new sources of data and develop new approaches and techniques.
• Provide guidance to lower level programmers/analysts.
• Lead, plan, organize, and/or coordinate complex projects or phases of large projects.
• Determine and resolve problems with other systems analysts, programmers, and systems users.

Senior Developer

Security Engineer

• Plan and perform compliance and risk assessment activities for information systems and related processes
• Communicate and escalate compliance and risk issues to the appropriate department and/or level of management
• Independently monitor remediation of new and outstanding issues
• Utilize tools to track and report on compliance posture
• Conduct formal risk analysis and self-assessments to determine effectiveness of controls
• Facilitate development, implementation and documentation of Information Security policies, procedures, processes and programs
• Analyze and interpret security regulations and controls to advise on security compliance
• Serve as an interface with external entities for governance and compliance reviews regarding information security risk
• Investigate, document and resolve Information Security Incidents
• Advise senior management of critical issues that may affect organization

IS Security Risk Analyst III

Director

• Lead, organize, and develop staff in administration of the Medical Review and Prior Authorization programs for government programs
• Directs and oversees the Medical Review and Prior Authorization programs ensuring performance expectations, compliance standards, workload issues, quality control, training and maintaining effective staffing levels and budgetary limits are maintained per the Center for Medicare and Medicaid Service (CMS) guidelines
• Guides the Medical Review Team in the development and implementation of an efficient and effective Medical Review Strategy, including the integration of policy and education, that optimizes critical Medical Review cycle times
• Serves as the Medical Review and Prior Authorization liaison between internal and external stakeholders
• Ensure system/operational compliance with CMS directives
• Establish, guide and analyze the effectiveness of Medical Review and Prior Authorization operations against benchmarks that are developed as measures of success
• Analyze performance trends and develop new/modified work processes to improve overall operations quality/timeliness/customer satisfaction/financial outcomes
• Direct/develop/evaluate/motivate subordinates to achieve and maintain production and quality standards ensuring area review decisions are accurate and all associates are well informed and trained on contract process work instructions
• Directs and oversees the development of the Medical Review and Prior Authorization Program strategy and error rate reduction plans based on the findings
• Develop and implement the Medical Review Programs strategic plan with goals supportive of the corporate strategic plan
• Manage budget to ensure cost effectiveness and performance quality
• Serve as the liaison and maintain proactive working relationship with CMS and other Medicare program leadership as needed by contract
• Investigate and resolve action items assigned by executive management
• Resolve priority level problems from providers, beneficiaries, and CMS

Senior Medical Review Director – Stop Loss

Accounting Manager

• Performs a variety of routine to moderately complex clerical/accounting functions
• Completes special projects
• Ensures data is complete, accurate, and organized for processing
• Provides supervisor with daily, weekly, and/or monthly summary reports of accounting activities
• Completes moderately difficult research using financial reporting systems
• Resolves routine questions and problems
• Performs calculations on financial documents
• Provides other support duties related to the accounting/finance function
• Determines, prepares, and distributes correspondence regarding monies due or erroneously received

Accounting Technician II

Systems Engineer

• Defines customer needs in technical and business contexts.
• Ensure the proposed technical and business solutions meet the customer's objectives for the work effort.
• Elicit and document user requirements to meet a business objective.
• Identify and validate requirements and organize the information into a logical document that is understood by the customer and Information Systems.
• Guide both technical and customer departments in the development of the systems that support the business solution.
• Ensure the accurate deployment of solutions through review of problem logs, assisting with test plans and test matrices, and other analysis activities.
• Validate the business need for solutions to business problems and process improvements.

Business Systems Analyst I

Medical Reviewer

• Performs medical reviews using clinical/medical information provided by physicians/providers and established criteria/protocol sets or clinical guidelines
• Documents decisions using indicated protocol sets or clinical guidelines
• Provides support and review of medical claims and utilization practices
• Makes reasonable charge payment determinations based on clinical/medical information and established criteria/protocol sets or clinical guidelines
• Determines medical necessity and appropriateness and/or reasonableness and necessity for coverage and reimbursement
• Monitors process’s timeliness in accordance with contractor standards
• Educates internal/external staff regarding medical reviews, medical terminology, coverage determinations, coding procedures, etc. in accordance with contractor guidelines
• Participates in quality control activities in support of the corporate and team-based objectives
• Provides guidance, direction, and input as needed to LPN team members
• Provides education to non-medical staff through discussions, team meetings, classroom participation, and feedback
• Assists with special projects and specialty duties/responsibilities as assigned by management

Medical Reviewer II

Data Analyst

• Analyzes data for creation of statistical reports used for program or process evaluation
• Responsible for maintaining databases and extracting data for analysis
• Runs and reviews reports, analyzing results in support of operational functions
• Reviews, extracts and analyzes data to be used in formulation of procedures, processes and other requirements
• Provides reports of relevant activity to be used to identify problematic areas and to provide basis for modification and/or elimination of operations issues
• Assists with development of complex analysis and sophisticated data compilation, verification, and interpretations to guide divisional efforts
• Performs focused analyses as needed
• Creates data search programs to identify pertinent data needed to provide supporting documentation for system or operational enhancements/changes
• Documents reporting procedures so other staff can run ad hoc reports independently
• Designs, codes, and maintains complex database programs for the extraction and analysis of data to support financial and operational decisions

Data Analyst II

Auditor

• Performs validation reviews of Diagnosis Related Groups (DRG), Ambulatory Procedure Codes (APC), and Never Events for all lines of business
• Coordinates rate adjustments with claims areas
• Provides monthly and quarterly reports outlining trends
• Serves as a resource in resolving coding issues
• Coordinates HIPAA and legal records requests for all areas of Healthcare Services and the Legal Department
• Determines methodology to identify cases for validation review
• Conducts validation reviews/coordinates rates adjustments with appropriate claims area
• Creates monthly/quarterly reports to present to each line of business providing information on records review, outcomes, trends, and savings that directly impact medical costs and contracting rates
• Manages records retrieval, release, HIPAA compliance, and all aspects of document management
• Serves as expert resource on methodology and procedures for medical records and coding issues

Quality Medical Auditor

• Develops comprehensive reports and analyzes data in order to identify patterns and trends
• Assists in creating materials that aid in illustrating analytical/data findings
• Identifies opportunities for improvement that can be addressed with educational initiatives
• Uses multiple software platforms to produce reports in accordance with work requests, internal initiatives, and requests from customers
• Codes, maintains, and executes simple to complex database programs for the extraction and presentation of data for standard and ad hoc reporting
• Develops supporting material and guidelines on report design and resulting data
• Evaluates data integrity to assure compliance with customer requirements and makes recommendations for corrective and preventative actions
• Provides input on database design
• Illustrates, other graphics, and narrative reports to identify and explain patterns and trends
• Assists with performing quality checks on new and existing relational database changes
• Creates support documentation outlining procedures