E-Verify Program

Vice President

• Drive medical cost management and healthcare value initiatives across the organization.
• Oversee Cost of Care Analytics, Healthcare Value Strategy, and Healthcare Value Operations.
• Partner with executive and health plan leadership, clinical operations, and finance teams to ensure sustainable cost containment and improved healthcare outcomes.
• Lead analytics to support Health Plan clinical operations and care management programs.
• Oversee provider and value-based contracting analytics, including performance measurement and incentive modeling.
• Direct pharmacy economics analysis to optimize drug spend and formulary strategies.
• Oversee evaluation of program ROI for Cost of Care initiatives and recommend enhancements.
• Maintain oversight of medical expense benchmarking and analytical tools for accurate forecasting and reporting.
• Develop enterprise-wide strategies to reduce medical costs and achieve health plan financial targets.
• Collaborate with cross-functional teams to identify opportunities for cost savings and value creation.
• Build business cases for new initiatives, including financial modeling and impact analysis.
• Ensure timely implementation and monitoring of programs designed to improve healthcare value.

VP, Medical Economics

Analyst

• Provide clinical consultation with non-clinical staff within the Appeals Department
• Coordinate all aspects of the appeals process to ensure compliance with medical necessity criteria and other requirements
• Analyze complex/non-routine member and provider appeals
• Present analysis and documentation to appropriate physician committee and BCBSNC leadership
• Provide written documentation of case determinations and handle complaints/grievances as defined by the federal government

Clinical Appeals Analyst

Business Operations

• Support the implementation and continuous improvement of digital procurement tools and systems.
• Serve as subject matter expert of major digital tools supporting Procurement.
• Conduct analysis to identify opportunities for process optimization and automation in procurement operations.
• Assist in the development and enforcement of procurement standards, best practices, and governance frameworks for market research suppliers.
• Collaborate with internal stakeholders to ensure procurement strategies align with business objectives and compliance requirements.
• Monitor supplier performance and adherence to contractual obligations, identifying areas for improvement.
• Research industry trends and emerging procurement technologies to enhance the organization's digital procurement capabilities.
• Support training initiatives to ensure proper adoption of procurement tools and adherence to standards.
• Generate reports and analytics to inform procurement strategies and decision-making.

Senior Business Operations Advisor – Procurement Excellence, Digital Tooling, Market Research, Operations

• Develop and maintain spend taxonomy to ensure accurate categorization and classification of procurement data.
• Generate spend reporting insights to support sourcing strategies, budget planning, and cost optimization.
• Track, measure, and report on savings achieved through procurement initiatives.
• Design, develop, and maintain dashboards that visualize procurement data and KPIs for effective decision-making.
• Partner cross-functionally across procurement teams to understand data needs and provide analytical support.
• Leverage tools (such as Excel, Power BI, Tableau, and/or procurement-specific software) to extract and analyze procurement data.
• Collaborate with Finance to align spend reporting, savings tracking, and budgeting processes.
• Identify opportunities for process improvements within procurement analytics and reporting functions.

Senior Business Operations Advisor – Procurement Excellence, Analytics and Reporting

Manager

• Develop performance goals and track performance against established goals.
• Handle complex employee issues.
• Conduct random audits of teams work.
• Review audit results with staff and create performance improvement plans as necessary.
• Develop and implement training plans to ensure growth and development for staff.
• Develop staff provider relation skills and provider communication through formal and informal training, coaching, and feedback.
• Interpret and analyze complex data from staffing models and other sources to identify issues and make recommendations for effective solutions.
• Develop resource allocation strategies to meet changing business demands.
• Represent BCBSNC in stakeholder meetings to address stakeholder inefficiencies and to ensure contractual compliance.
• Plan all on-site visits to stakeholders to educate on BCBSNC medical or administrative policies and procedures.
• Address stakeholder concerns and non-compliance contract/administrative issues.
• Coordinate the required corrective actions.
• Partner with assigned stakeholders to understand their processes, procedures and systems as they relate to the way they conduct business with BCBSNC.
• Develop and maintain extensive knowledge of key stakeholders and/or regional territories.
• Track stakeholder issues for root-cause analysis, escalation, and closure.
• Document issue resolution using issue resolution protocol.
• Comply with state, federal and BCBSA regulations governing stakeholders and suggests implementation of any product, process, or system modifications to ensure compliance.
• Identify opportunities to control medical expense and deploy action plans to accomplish stakeholder-specific or regional medical expense goals.
• Participate in negotiations with stakeholders as needed.
• Manage day-to-day consultative activities for a high-profile healthcare system.
• Provide analysis and feedback for technologies, trends, best practices and service offerings to incorporate them into overall stakeholder business solutions.
• Lead team of onsite coordinators in identifying, analyzing, and resolving complex operational issues impacting the healthcare system.

VP, Medical Economics

Clinical Appeals Analyst

Senior Business Operations Advisor – Procurement Excellence, Digital Tooling, Market Research, Operations

Senior Business Operations Advisor – Procurement Excellence, Analytics and Reporting

Manager, Strategic Provider Support