E-Verify Program

Operations

• Manage day-to-day business area activities; provide leadership and direction to the team and set team goals and expectations
• Act as a technical resource for a team; provide assistance on system issues, work processes and procedures
• Train team members to ensure less experienced employees are able to respond professionally, courteously, quickly and accurately to all inquiries from internal and external customers
• Provide coaching and development feedback to the team
• Work with other departmental teams to review and set performance goals and track performance against these goals
• Identify trends, determine root causes, and initiate appropriate action to resolve issues
• Conduct random audits of the team’s work
• Review audit results with employees and create performance improvement plans as necessary
• May develop short and long-term service objectives and methods; implement these methods when approved
• Respond quickly and accurately to escalate issues from clients and customers
• Review customer needs and delivery commitments and review with team members
• May represent the department on corporate projects

Team Leader – Operations

Business Operations

• Develop and implement Continuous Quality Improvement framework and Monitoring and Evaluation plan
• Build and facilitate repeatable and Plan-focused strategic planning processes
• Advise and communicate with Plan leadership and external stakeholders
• Develop and use key improvement metrics, such as dashboards, team reporting, regulatory reports and scorecards
• Monitor and evaluate delegated staff functions activities for compliance and effectiveness
• Proposes a variety of solutions to business issues/problems utilizing appropriate analysis tools
• Lead the development of a Monitoring and Evaluation Plan
• Lead the coordination, planning, and facilitation of various Plan-level monitoring and evaluation workgroups
• Lead monitoring and evaluation strategy development and activities
• Support development of business plans and analysis under guidance from Plan leadership
• Facilitate the adoption of CQI-driven Plan operating procedures
• Provide input and recommended strategy for Plan leadership’s public speaking engagements
• Facilitate change management work to support business and process improvements
• Lead and coordinate work for special projects or initiatives for the Plan as assigned
• Serve as lead on engagements with external entities
• Manage tracking of initiatives/projects for the division

Principal Business Operations Advisor

Program Manager

• Develop project plans and recommendations in support of Plan objectives and leads implementation; tracks and reports on the status of the project
• Must ascertain, categorize and manage projects in relation to Plan priorities.
• Coordinate data sharing and integration across systems to enable comprehensive performance analysis.
• Use dashboards, team reporting, regulatory reports and other artifacts to develop Plan-level insights on Plan functions within Care Management, Provider Network, and Cross-collaboration teams.
• Track headwinds and tailwinds impacting overall program performance.
• Ensure data accuracy and usability for decision-making.
• Ensure timely execution of improvement plans and monitor progress against defined goals.
• Delegates assignments and monitoring progress as required to ensure a timely completion of deliverables.
• Coordinate development and implementation of policies and procedures as well as development of monitoring and evaluation benchmarks.
• Control and monitor project effectiveness, update project plans as necessary.
• Ensure compliance with necessary audit requirements.
• Assist with analysis and development of business processes to ensure quality, cost effectiveness, timeliness of customer service, and regulatory requirements and mandates are met.
• Develop escalation process to channel issues and concerns to appropriate parties.
• Evaluate project risks, develop contingency plans and respond to change in risk as the project progresses.
• Develop effective business process improvement initiatives and communication plans.
• Perform analytic functions and coach staff in analytical production, technical and other areas.
• Document and present project management results through the development of criteria, issue analysis papers and reports
• Track budgets, operating plans and financial cost forecasts to support the objectives of the project.

Senior Program Manager

Analyst

• Develops complex decision support data applications, data extracts, files, reports, data marts, and/or analysis.
• Responsible for entire development life cycle.
• Manages the Maintenance and optimization of the Actuarial Systems Data Marts.
• Establishes vendor and interdepartmental relationships to ensure the accuracy and completeness of financial data.
• Serve as the lead for multiple application areas, including data definitions, usage and file structure, technical structure of the code and the business rules, and structure of requirements that governs the functionality of the system.
• Leads in developing data applications, extracts, reports, or analysis by providing input to the business requirements and functional specifications, reviewing technical specs (to make sure all business requirements are met), participating in the user acceptance testing process, and attend all meetings required to support the project effort.
• Independently analyze business problems or opportunities; develop recommendations and solutions, implement those solutions, and provide communications on the associated actions, business impacts, and results.
• Performs monthly data refreshes, validations and quality assurance checks to support executive financial reporting’s.
• Ensures Financial granular detail data is appropriately auditable, snapshotted and stored for quarterly and year end audits.
• Provide analytical support for departmental, divisional and corporate projects as needed to accomplish their business goals and to ensure the business needs are met.
• Coordinate work and provide direction, assistance and training to peers and junior staff members.
• Keeps abreast of changes in the company and with our external vendor; data that affect the departmental processes & systems, make recommendations of actions needed and implement changes to the applicable Actuarial Systems and processes where needed.
• Provide technical leadership and application expertise to business project teams and non-project related activities for the full understanding and execution of all types of assignments.
• Plan and serve as a key liaison with business areas during development and implementation.
• Provide detailed configuration expertise to customers and business partners. This includes verbal, written, and electronic communication, and delivering presentations when needed.

Principal Business Applications Analyst

• Responsible for completing process performance measurement analytics and trending analysis.
• Compile recommendations for process and system improvements based on operational and financial performance metrics, and lead process improvement projects end-to-end for business areas.
• Develop and maintain strategic working relationships with business leaders.
• Partner with Leaders to create the departmental improvement plan, based on segment priorities and goals.
• Facilitate change management work to support business and process improvements and overall departmental/divisional effectiveness.
• Independently identify and manage initiatives of significant scope and complexity.

Senior Business Operations Advisor

Manager

• Lead the design, development, and execution of formulary strategies (Part D and Part B) for all Medicare formularies, including MAPD (HMO, PPO, DSNP), PDP and EGWP.
• Collaborate with cross-functional partners-including Medicare Pharmacy Operations, UM Operations, Compliance, STARS, Medical Management, Actuary, Product, Clinical, and Finance teams to ensure formularies are clinically appropriate, cost-effective, competitive in the marketplace, and compliant with CMS regulations.
• Leads the annual Medicare formulary planning process from kick-off through CMS submission and final approval.
• Develops and executes Medicare formulary strategies that balance clinical efficacy, cost-effectiveness, compliance, and competitive positioning.
• Conducts competitive analyses, assesses rebate and lowest net-cost opportunities, evaluates customer cohort profitability analyses, and product-specific strategies aligned with evolving product and market needs.
• Supports the development of custom formularies tailored to the needs of each Medicare product.
• Researches market trends, evaluates competitive positioning, and assesses the regulatory landscape to guide Medicare formulary strategies.
• Participates in the Pharmacy & Therapeutics (P&T) and Business Assessment Committee, ensuring evidence-based decision-making and CMS compliance.
• Partners with Actuarial, Finance, Clinical and Product teams to model financial scenarios, assess member impact, and evaluate competitive positioning.
• Conducts ongoing and ad hoc reviews focused on specialty tiers, utilization management, STARS performance, and high-cost/high-trend drugs.
• Ensures P&T compliance with CMS regulatory standards.
• Works with PBM and internal partners to ensure CMS approval of formularies.
• Monitors emerging drug trends, competitive market dynamics, and utilization patterns to proactively identify opportunities or risks.
• Partners with Actuary and Data & Analytics teams to conduct analyses of formulary performance, including customer cohort profitability, trend tracking, UM performance, and tier exception reviews.
• Refines strategy based on market intelligence and performance insights.

Manager – Medicare Formulary Strategy

Director

• Oversee day-to-day cash management (approximately $18 billion of cash throughput) by controlling cash flow, projecting cash balances, maintaining optimal liquidity position, and maintaining short-term credit lines for liquidity purposes.
• Refine and enhance cash forecasting to drive proactive decision making.
• Lead teams who manage the transactional work of incoming receipts and cash balancing.
• Build programs to simplify and integrate processes within Treasury Operations.
• Drive the use of technology to improve operational metrics (accuracy, timeliness, and service levels).
• Manage third party vendor to ensure accuracy and timeliness of work and to reduce cost to serve.
• Work closely with Investment team to manage short-term cash and investments.
• Work with direct reports to create career development plans by identifying and documenting appropriate career and skill development goals, milestones and measures.
• Maintain and foster strong relationships with key bank partners optimizing bank solutions for process improvements.

Director, Treasury Management

Consultant

• Develop and implement federal advocacy strategies aligned with enterprise priorities.
• Primary lobbyist before Congress, federal agencies, and the Administration.
• Monitor and analyze federal legislative and regulatory developments; advise leadership on impacts and positions.
• Prepare testimony, briefings, and policy materials for senior executives.
• Build coalitions with national trade associations and advocacy organizations.
• Ensure compliance with federal lobbying disclosure and ethics requirements.
• Provide strategic guidance for PAC activities and political engagement.
• Prepare and deliver regular, often quarterly, reports to clients on lobbying activities, including contacts made, issues discussed, and the outcomes of those discussions.
• Advise clients on federal advocacy efforts, policy impacts, and the potential outcomes of legislation.
• Network with elected officials, staff, and decision-makers to gain access and influence.
• Directs and implements public affairs strategies to support government and commercial insurance and healthcare delivery business-related activities, including both business expansion and retention opportunities, procurement opportunities, and various initiatives.
• Leads federal commercial and government segment and healthcare delivery strategies through identification and monitoring of changing patterns of the regulatory and legislative environment, by identifying public policy priorities, refining initiative scope, tracking value delivery, and shaping policy/advocacy tactics and messaging.
• Ensures alignment and integration with public affairs and divisional and initiative plans and business goals.
• Represents Blue Cross NC externally, serving as an expert resource and contact for the enterprise with federal officials and external stakeholders, including national advocacy and trade organizations, professional societies, medical associations, and other external constituencies.
• Researches and analyzes major competitor and industry to provide insight to aid the company’s short and long-term business strategy.
• Implements effective management, monitoring and oversight approaches that drive execution, focus and results for all assigned initiatives and recommend and implement changes as needed to ensure enterprise business objectives are achieved.
• Works in partnership with other key internal stakeholders, develops both short- and long-term performance targets, forecasts and projections with appropriate performance monitoring and management.
• Maintains compliance as appropriate and successfully leverages capabilities and insights of policymakers, industry associations and other peer plans and stakeholders.
• Budget responsibilities to control expenditures in accordance with budget allocations.

Public Affairs Consultant, Federal Affairs Lobbyist

Security Engineer

• Shape security architecture: Provide expert technical guidance in the design, implementation, and operation of global IT security technologies, tools, and infrastructure.
• Administer and optimize security tools: Perform advanced system administration of security platforms, including applying updates, patches, and configurations to harden defenses.
• Lead security reviews: Coordinate and execute thorough security assessments of new and existing applications to ensure alignment with internal policies and industry best practices.
• Partner across IT: Build strong relationships with IT operational teams to strengthen our security posture and drive ongoing improvements in processes and controls.
• Resolve critical incidents: Lead response and resolution efforts for complex or high‑visibility security issues, providing guidance and mentorship to junior team members.
• Conduct specialized testing: Perform advanced investigations and testing related to Identity & Access Management (IAM) and Threat & Vulnerability Management (TVM).
• Improve processes: Proactively identify opportunities to enhance security operations, and design, revise, and maintain Standard Operating Procedures (SOPs), working instructions, and related documentation.

Senior Security Engineer

Account Executive

• Build and maintain effective relationships with Producers and Consultants to meet target marketing plans for new and renewal business
• Sell, prospect and service by managing time and territory effectively
• Assist in developing marketing strategies for agencies
• Manages producer expectations through a consultative relationship approach
• Responsible for representing BCBSNC and project the corporate image to Producers/Consultants and decision makers, anticipate needs and reactions of both
• Explain corporate policy and its efforts to contain rates through health care cost containment, utilization review, etc.
• Develop, implement, and present sales and retention strategies to Producers/Consultants that focus on BCBSNC key strengths and differentiators to help close accounts and maximize membership growth
• Sells Individual rate increases through effective communication with Producers
• Manages the individual renewal process
• Maintain current, accurate , and in-depth knowledge of corporate policies and procedures relative to benefits, rating, claims, billing, e-commerce tools, service capabilities and overall industry knowledge
• Keep abreast of market trends, activities and products of competitors and the economy
• Plan sales strategies which reflect knowledge of all forces affecting the marketing of health care insurance
• Collaborate and negotiates with internal and external partners to find solutions that meet the customer’s needs
• Use all available approved marketing strategies to increase BCBSNC membership in assigned territory
• Responsible for analyzing territory to determine appropriate number of producing agents to achieve sales and retention objectives
• Provides Producer/Consultant training on BCBSNC products and services
• Uphold compliance standards
• Ensure proper, timely and accurate response to inquiries, and timely and accurate submission of internal reports
• Make recommendations and suggestions for product and procedural additions/changes when deemed necessary to achieve sales and service goals and objectives
• Ability to travel up to 40% of the time

Regional Sales Executive

• Provides leadership and oversight of the Quality Testing and Delivery Team
• Works with all stakeholders to drive Quality related strategies with a focus on reducing operating expense/ transaction costs while ensuring a superior customer experience
• Provides thought leadership and IT transformation recommendations in various technology areas
• Responsible for the centralized and coordinated IT quality management of projects and initiatives
• Lead the establishment of consistent methodologies, processes, tools, infrastructure and metrics across the SLDC

Director, IT Quality

Actuary

• Applies advanced knowledge of mathematics, probability, statistics, health insurance, and principles of business in order to provide assistance and technical support for extensive and more complex rating/pricing, valuation, and financial forecasting.
• Works with a team of actuaries to assure a coordinated approach to the actuarial components of health programs.
• Provides actuarial support to Network Management, Underwriting, and Sales and Marketing.
• May have team leadership responsibilities, especially on specific projects.
• Develop and maintain actuarial models to support the Medicare Advantage bid process and other Medicare pricing efforts.
• Perform actuarial research, experience studies, and statistical analyses using Excel, SQL, and SAS.
• Provide ad-hoc analytic and pricing support for corporate and departmental projects.
• Communicate effectively with actuarial peers, key internal customers, and direct leadership.

Principal Actuary – Medicare Pricing

• Serve as the subject matter expert for application areas, including data definitions, usage and file structure.
• Lead development of Package Software modification requirements and Interface Design Specifications.
• Independently analyze business problems or opportunities; develop recommendations and solutions for those problems/opportunities.
• Facilitate completion of projects within the allocated time and budget.
• Provide direction and assistance to junior staff members.
• Provide detailed configuration expertise to customers and business partners.

Senior Business Applications Analyst

• Manage staff responsible for the development and execution of sourcing strategies.
• Direct and train staff in conducting sourcing events.
• Partner with stakeholders to develop business and sourcing strategy.
• Coordinate the evaluation and analyses of sourcing results.
• Participate in cross-functional teams responsible for complex vendor negotiations.
• Review and lead supplier relationship management.
• Drive vendor engagement through formal and informal transactions.
• Coordinate vendor risk assessments and develop plans to track and address significant risks.
• Manage contract management function.

Manager, Healthcare Category Management

• Serve as a team member on a multidisciplinary team, coordinating care, resources and/or services for members to achieve optimal clinical and resource outcomes.
• Utilize applicable clinical skillset and perform comprehensive assessments to determine how to best collaborate with members, family, internal partners and external services/providers on plans for treatment, appropriate intervention and/or discharge planning.
• Develop a member-centric plan tailored to members’ needs, health status, educational status and level of support needs; identify barriers to meeting goals or plan of care
• Utilize community resources and funding sources as needed in the development of the plan of care.
• Perform ongoing monitoring and management of member which may include scheduled follow-up with member, discussion of plan with member, appropriate services/education to address needs, appropriate referrals with supporting documentation, assessment of progress towards goals, modification of plan/goals as needed, with contact frequency appropriate to member acuity.
• Evaluate and facilitate care provided to members through the continuum of care (physician office, hospital, rehabilitation unit, skilled nursing facility, home care, etc).
• Educate members and encourage pro-active intervention to limit expense and encourage positive outcomes
• Effectively document all aspects of the plan from the initial assessment, development of the plan, implementation, monitoring, and evaluating outcome.
• May outreach directly to members identified as high risk, high cost, or high utilization cases.
• May review alternative treatment plans for case management candidates and assess available benefits and the need for benefits exception or flex benefit options, where eligible.
• May evaluate medical necessity and appropriateness of services as defined by department.
• As needed, develop relevant policies/procedures, education or training for use both internally and externally.