E-Verify Program

Sales

• Lead and manage a Salesforce team through successful delivery of solutions to address business needs.
• Manage on-going maintenance of related systems.
• Manage relationship with business and technology partners.
• Perform all people leader tasks.
• Maintain and enforce ideal architecture for applications under his/her domain.
• Deliver complex communication of status and issues to senior leadership, VPs, and stakeholders in a clear and concise manner.
• Accountable for managing relationship with business, vendors and other delivery partners.
• Perform analytic functions and coach team members in technical and analytical production.
• Responsible for end-to-end vendor management for IT partners.
• Provide direct reports with well-defined job expectations, ongoing performance feedback, accurate and timely performance appraisals, coaching, mentoring, training,

IT Solution Delivery Manager, Salesforce

Analyst

• Analyze, research, resolve and respond to confidential/sensitive appeals, coding disputes, grievances and coverage/organization determinations.
• Analyze, interpret, and explain health plan benefits, policies, procedures, medical terminology, coding to members and/or providers.
• Regularly and independently exercise judgement to make appropriate decisions based on BlueCross NC policies and guidelines.
• Acts decisively to ensure business continuity and with awareness of all possible implications and impact.
• Prepare files and develops BlueCross NC position statements for external reviews performed by independent review organizations, benefit panels and external medical consultants.
• Provide comprehensive appeals, coding disputes and grievances responses that support the decision and comply with regulatory and accreditation guidelines.
• Document extensive investigation, relative findings, and actions in all applicable systems.
• Accountable for monitoring daily reports to ensure service timeliness and compliance is met.
• Gather clinical information by using established criteria provided in corporate medical policies; partner with Medical Directors who are responsible for all decisions regarding clinical appeals/grievances.
• Ensures timeliness, quality, and efficiency in all work to comply with applicable mandated State and/or Federal accreditation agency standards.

Appeals Analyst

Performance Marketing

• Lead demand generation strategy, planning, and execution, including budget allocation, channel mix, and performance measurement aligned to business objectives
• Develop and execute integrated, omni-channel campaigns (digital, direct response, CRM, and email) that drive pipeline growth and customer engagement
• Partner across business functions to identify growth opportunities and translate customer and market insights into actionable marketing strategies
• Leverage data, research, and customer intelligence to inform targeting, messaging, and channel optimization decisions
• Build and optimize media strategies that improve brand affinity and drive measurable demand outcomes
• Lead and develop a high-performing team, providing coaching, direction, and clear expectations to elevate team capability and performance
• Operate with strong ownership and accountability, proactively driving initiatives from concept through execution and results

Director – Demand Generation

Program Manager

• Develop and maintain the health plan’s provider education program for coding, documentation, and billing integrity issues
• Establish program workflows, referral criteria, outreach templates, monitoring schedules, escalation pathways, and reporting standards
• Create standardized processes for provider identification, educational intervention, follow-up review, and referral to SIU when concerning behavior persists
• Analyze claims, coding, utilization, reimbursement, and provider billing data to identify outlier patterns
• Conduct targeted reviews to determine whether provider billing patterns warrant education or further escalation
• Draft and issue provider education letters that clearly describe identified billing concerns
• Conduct provider outreach calls and meetings to review findings, explain coding or documentation expectations, answer questions
• Perform quarterly and semiannual post-education monitoring to assess whether provider billing behavior changes
• Develop and administer a formal referral process to SIU for providers whose billing patterns do not improve

Provider Education Program Manager – Payment Integrity

Actuary

• Analyzes financial, statistical and mathematical data and performs actuarial calculations.
• May assist in the determination of pricing, reserves and/or cash flow projections.
• Assists in performing rate studies used in determining rate adequacy.
• Assists in actuarial research, experience studies, and statistical analyses and calculations.
• Provides support to senior analysts or actuaries as required.
• Retrieves and validates data for rate filings and actuarial models.
• Assists senior staff in the building of model enhancements and determines reasons for changes to calculated factors.
• Distributes established reports and responds to inquiries.
• Investigates trends and anomalies.
• Supports Enterprise Risk Management.
• Provides analytic support for corporate and departmental projects.

Actuarial Associate

Procurement

• Supports the sourcing and contracting function at the enterprise level ensuring that supply, equipment, and services contracts are appropriately managed and are accurately maintained.
• Leads the contract lifecycle process.
• Works with clinical and administrative leadership at all system sites, leads or participates in cross-functional multi-site decision teams from initial requirements definition through the contract award process.

Contract Management Specialist

• Oversees Allina Health’s Capital Planning program, including the development and execution of business plans, capital and operating budgets, and forecasts
• Oversees annual capital budgeting process in alignment with annual and long range financial plan
• Creates strategic alignment with executive leadership, finance leadership, service lines, business units, and key stakeholders as it relates to Allina Health’s capital planning and approval process
• Manages relationships with internal partners in accordance with the organization’s overarching strategies
• Monitors progress and financial performance of approved plans, projects, and investments and escalate barriers to execution
• Ensures adherence to finance standard work and optimal utilization of available tools and resources

Program Manager – Capital Planning and Fixed Assets

Project Manager

• Leads enterprise-wide, cross-functional, large-scale key organizational strategic project management (multi-million-dollar projects +)
• Responsible for driving alignment, organization and successful delivery of projects
• Responsible for supporting the development, implementation and sustainment of an industry standard project portfolio management process
• Oversees key project planning, execution and monitoring deliverables including timeline and cost
• Mentors other leaders and project managers

Senior Project Manager – System Strategic

Manager

• Perform clinical reviews to assess, facilitate, and coordinate the delivery of health care services for members based on medical necessity and contractual benefits.
• Effectively coordinate with providers, members, and internal staff to support the delivery of high quality and cost-effective care across the health care system.
• Review and evaluate cases for medical necessity against medical policy, benefits and/or care guidelines and regulations.
• Complete work in accordance with timeliness, production, clinical quality/accuracy and compliance standards.
• Provide notifications to member and/or provider, according to regulatory requirements.
• Assess appropriateness for secondary case review by the Medical Director (MD) for denials and coordinate as needed.
• May coordinate peer-to-peer review upon provider request when members’ health conditions do not meet guidelines.

Episodic Care Manager

Director

• Leads the strategy and implementation of initiatives to ensure children and youth in North Carolina grow up in strong and supportive communities that provide them and their families with the best opportunity to be mentally healthy and thrive across prevention, early intervention, and care systems that span schools, communities, and health care
• Work closely with other senior leaders to create an enterprise-wide strategy, partnering with internal teams and external organizations to make a meaningful impact on youth mental health through activities
• Oversee grantmaking efforts, manage a team, and facilitate enterprise-wide and cross-sector collaborations to achieve the organization's goal of improving youth mental health
• Exercise strategic judgment in deploying grantmaking, contracts, and partnerships to advance systems level outcomes
• Manage grantmaking activities and contracts across a diverse portfolio
• Engage directly with grantees to support their work through capacity building, thought partnership, connections to resources, and facilitating introductions to support their goals
• Convene and facilitate enterprise-wide councils to inform strategy, clarify priorities, and identify, track and report on KPIs and other accountability metrics
• Partner with leaders in the business to identify where philanthropic and community insights and business capabilities can be mutually reinforcing
• Build and leverage cross-sector relationships with community and state leaders including potential applicants, grantees, advocates, policy makers, and other funders to identify and advance solutions collaboratively
• Represent the organization at community events, conferences, and other forums through speaking engagements and written pieces to advance the mission to improve health for all.

Director, Youth Mental Health

Systems Engineer

• Develop complex decision support data solutions, data extracts, reports, data marts, and/or analysis.
• Performs monthly data refreshes, validations, automations, and quality assurance checks to support executive financial reporting.
• Manages the Maintenance and optimization of the Actuarial Systems Data Marts.
• 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 govern the functionality of the system.
• Independently analyze business challenges or opportunities; develop recommendations and solutions, implement those solutions, and provide communications on the associated actions, business impacts, and results.
• Establishes vendor and interdepartmental relationships to ensure the accuracy and completeness of financial data.
• Lead in ensuring 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.
• Lead in developing data solutions and/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 attending all meetings required to support the project effort.
• Coordinate work and provide direction, assistance and training to peers and junior staff members.
• Provide technical leadership and data 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 Actuarial Data Systems Analyst

• Join a team where technology meets strategy.
• Perform appropriate analysis, development and logic implementation to ensure the quality and accuracy of data/applications delivered.
• Manages the maintenance and optimization of the Actuarial Systems Data Marts
• Performs monthly data refreshes, financial validations and quality assurance checks to support Actuarial reporting and analytics
• Independently analyze business problems or opportunities; develop recommendations and solutions, implement those solutions, and provide communication on the associated actions, business impacts, and results.
• Develop decision support solutions; including medical and pharmacy claim financial data builds, data extracts, reports, data mart tables, views and analysis.
• Establish vendor and inter-departmental relationships to ensure the accuracy and completeness of financial data.
• 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

Senior Actuarial Data Systems Analyst

Financial Planning and Analysis

• Manage staff responsible for the application security, administration, implementation and maintenance of processes and procedures related to the effective oversight of Financial Systems.
• Oversees communications, training programs, and performance reporting.
• Report on Financial System performance including incidents, problems, relevant Service Level Agreements (SLAs) and compliance.
• Provide leadership and management of all Finance data governance practices and processes.
• Ensure compliance with corporate policies, support internal and external audits and proactively maintain process and controls and recommend process improvements where necessary.
• Assist with systems-related needs assessments, cost benefit analyses, and definition of business requirements and functional specifications.
• Manage the implementation of system fixes and upgrades for financial reporting related systems (e.g. Lawson, PAM, SAS FM).
• Coordination with IT and HR.
• Lead cross-functional system projects and facilitate communication throughout the department on the progress of pending systems projects.

Manager, Financial Systems

Operations

• Performs line-locating requests
• Performs customer service functions, including cashiering and answering customer inquiries
• Performs limited field service work, including connects, disconnects, and leak investigation following qualifications
• Performs meter-reading activities, mapping, and drafting duties
• Performs leak survey functions, including annual transmission and distribution system surveys, public building inspections and line-locating requests
• Performs storekeeping and warehousing duties including document and report processing, receiving, and issuing supplies, and posting receipts and issues
• Investigates requests and prepares measurement and cost estimate data for work orders through contact with customers, contractors, government officials, and field inspection

Operations Rep, Senior Operations Rep

Human Resources

• The Leave of Absence and Benefits Specialist is responsible for the administration, compliance, and continuous improvement of all US leave of absence programs.
• This role serves as the subject matter expert for benefits and leave, including Family Medical Leave Act (FMLA), Minnesota Paid Family and Medical Leave (PFML), parental leave programs, multi-state leave requirements, and other leave types.
• Manage all leave and disability programs including: FMLA, ADA accommodations, Short- and long-term disability, Company parental leave programs, unpaid company provided leave.
• Ensure compliance with federal, state, and local leave laws and regulations.
• Develop and maintain expertise in multi-state leave programs.
• Track and manage leave cases end-to-end (documentation, timelines, approvals, return-to-work coordination, pay information).
• Provide guidance to managers and employees on leave eligibility, documentation, and expectations.
• Partner with third-party administrators to ensure effective case management.
• Prepare and submit required filings.
• Conduct regular audits of benefits and leave data to ensure accuracy and compliance.
• Support onboarding and offboarding processes related to benefits and compliance.
• Respond to employee inquiries related to benefits, leave, and HR policies.