E-Verify Program

Director

• Direct end‑to‑end BlueCard claims processing, adjustments, and financial recovery activities.
• Develop the strategic vision and key processes for the provider contact center.
• Partner with Operational leads and workforce management to supplement strategy.
• Direct and improve Strategic Provider Services offering, maintaining close relationships with key providers.
• Oversee support of non-platinum providers through virtual contact centers.
• Ensure plan-to-plan contacts are handled in line with BCBSA standards and service level expectations.
• Communicate with managers and team leads on the provider service strategy.
• Resolve complex escalations and contribute to training development.
• Monitor and review service performance ensuring that provider service agreements are met.
• Report operational updates to the Claims AVP and Operations VP.
• End to end inventory management to align with all regulatory guidelines.

Director, Provider Service – BlueCard Claims

Artificial Intelligence

• Own delivery of large and/or complex ML, DL, and Generative AI systems
• Design, implement, and evaluate AI systems for production
• Apply prescriptive analytics techniques to business problems
• Lead development and testing of ML algorithms
• Stay updated with advancements in AI/ML methods
• Benchmark against existing ML methods
• Develop prototypes and proof-of-concept implementations
• Lead consultation sessions with business partners
• Drive continuous improvement through novel techniques
• Identify actionable insights and communicate results

Senior AI/ML Scientist

Data Analyst

• Construct, design, write and document complex programs using Business Intelligence Tools (e.g. Business Objects, SAS, SQL, Crystal Reports)
• Develop, analyze, report and interpret complex data for ongoing activities/projects
• Work collaboratively with customers to complete effective needs analyses
• Monitor and perform in-depth analysis of data for customers to determine areas of improvement
• Identify complex trends and make recommendations to business areas
• Communicate meaningful insights by creating charts and slide presentations
• Support and manage complex applications systems on many platforms
• Provide ongoing user support for ad hoc reporting, questions, queries, and problem support

Senior Healthcare Data Analyst, ACA, EDGE

Analyst

• Conducts investigations in accordance with investigative action plan and documents all findings in standard with SIU Policies and Procedures
• Identifies errors and control deficiencies.
• May be required to provide deposition and/or testimony
• Conduct interviews of victims, subjects and/or other related persons
• Prepares and conducts presentations and/or provides content for health care fraud and abuse education and awareness.

Senior Fraud Investigations Analyst

Financial Planning and Analysis

• Lead the development of analysis and reporting for financial information used in monthly, quarterly, and/or annual reporting including historical and/or forecasted financial information.
• Review and approve financial plans, financial forecasts, profitability impacts & competitive analysis, and various reports to better track profitability.
• Drive the preparation of financial and business-related analysis and research.
• Oversee the development of budgets for the department based on actual performance, previous budget figures, estimated revenue, expense reports and other factors.
• Serve as the lead business partner to Sales & Marketing on self-funded group matters; serve as a subject matter experts on self-funded billing/collection/invoicing issues.
• Proactively identify areas of improvement and recommend process enhancements to management.
• Review, approve, and support the creation of monthly, quarterly, annual, and ad hoc reporting for use by senior leadership, the Board of Trustees, the BCBS Association; ensure such reporting is accurate and make presentations to management as needed.
• Respond quickly and accurately to escalated issues from internal and external clients and customers.

Team Leader, Financial Reporting

Medical Director

• Bring knowledge and skills to the business of Blue Cross North Carolina
• Support value-based strategies and clinical operations
• Develop and drive strategy for varied Health Care initiatives
• Partner with internal and external clients to support agreements
• Evaluate and manage vendors to align with strategic direction
• Gather and analyze data for health outcomes improvement
• Represent BCNC through presentations and leadership

Associate Medical Director

Program Manager

• Manage/Administer smaller programs or a phase of a larger program to ensure that prescribed activities are carried out in accordance with program objectives.
• Assess needs and coordinate resources to enhance existing programs.
• Monitor the progress of program components to ensure the overall goals, schedules, and benefits of the program will be met.
• Document and present program results through operational reports, outcomes studies, presentations, and publications.
• Prepare program reports for leadership superiors.
• Recommend and/or implement program and process changes as needed to achieve program goals and objectives.
• Serve as a liaison between teams to collect updates and integrate input effectively.
• Track issues requiring escalation and ensure follow through on action items.
• Assist with planning, process updates, and development of simple frameworks, templates, and documentation.

Program Manager, Health Plan Governance, Performance

Strategy

• Responsible for leading the development, evaluation, management, and governance of Health Plan performance
• Work directly with staff and senior leadership across the company to proactively identify and prioritize strategic needs and create meaningful and actionable outputs
• Design and own governance operating models that drive accountability across areas of the business
• Develop and maintain relationships with both internal and external partners to drive complex project/initiative work
• Consolidate research, authorship of key findings, and communication of timely strategic intelligence reports to senior management and Blue Cross NC Board
• Partner and consult with internal clients to identify, plan and execute innovation efforts; help them better understand what problems they are trying to solve

Senior Strategic Advisor, Health Plan Strategy

Actuary

• Develops reporting structure, toolset and analytic strategy to support market and domain teams as well as pricing for programs and products.
• Supports the rating process by determining the need for and building actuarial model enhancements.
• Distributes established reports and responds to inquiries.
• Supports the investigation of trends and anomalies.
• Coordinate and independently develop BI content (reports, dashboards, scorecards, more complex analytic solutions) through the entire development life-cycle to provide data necessary to effectively make business decisions and measure goal attainment and overall performance.
• Share expertise with business areas to assist in understanding enterprise data content, definitions and usage and the available BI tools.
• Maintains robust knowledge of data assets and tools and supports development/maintenance of a formal Knowledge Base.
• Plans, implements, manages and/or contributes to projects that are moderate/high complexity.

Senior Actuarial Analyst – Medical Economics

• Leads financial planning, target-setting, and forecasting activities to support enterprise performance management and cost discipline.
• Guides the design and evolution of financial operating models and cost structures, ensuring alignment with strategic and operational priorities.
• Drives continuous improvement in FP&A processes, governance, reporting, and automation to increase efficiency, transparency, and decision support.
• Establishes financial assumptions, planning parameters, and performance frameworks to support consistent and reliable guidance.
• Partners with business and functional leaders to align forecasts, reconcile assumptions, and provide integrated financial perspectives.
• Provides oversight of financial analysis across a broad scope of business activities and adapts support as organizational priorities evolve.
• Communicates with executive presence, translating business performance, operational drivers, and strategic initiatives into clear financial insights and recommendations.
• Ensures reporting, analysis, budgeting, forecasting, cost allocation, staffing, and benchmarking activities align with enterprise financial frameworks and business objectives.
• Leads development of business cases, performance models, and financial frameworks for key initiatives, and monitors outcomes against expectations.
• Builds organizational capability by developing talent, strengthening leadership readiness, and advancing a strategic advisory approach within FP&A.
• Serves as a key finance partner across the organization to address complex business issues and promote stewardship, accountability, and effective management of enterprise resources.

Senior Manager, Financial Planning & Analysis

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
• Performs meter-reading activities, mapping, and drafting duties
• Performs leak survey functions, including annual transmission and distribution system surveys
• Investigates requests and prepares measurement and cost estimate data for work orders

Operations Rep – Senior Operations Rep

Security Engineer

• Provide technical input into the design, deployment and operation of global IT Security management software and hardware devices.
• Perform security tool system administration, including applying updates and patches.
• Review existing applications periodically as well as new applications prior to installation to ensure adherence to security policies and industry best practices.
• Proactively engage in discussions with IT operational teams to maintain and improve security posture.
• Work to resolve security issues or incidents.
• Perform applicable testing and investigations related to Information Security, Identify Access Management or Threat and Vulnerability Management.
• Develop, revise and maintain relevant Standard Operating Procedures and Working Instructions related to IT Security and engineering with a focus on ongoing improvement.

Business Intelligence Developer

• Leading the design and development of high quality, user-friendly analytic visualizations
• Work with the analytics team to deliver key strategic insights
• Mentor and provide knowledge transfer to junior team members
• Collaborate with business areas to ensure analytics work delivers high ROI value
• Facilitate cross-functional problem solving sessions
• Provide team status in various projects

Senior BI Analyst

• Support the development, writing and refinement of Commercial and Medicare Advantage reimbursement policies
• Support implementation of healthcare reimbursement strategies
• Assist with critical strategic planning and thought leadership
• Present reimbursement policy concepts and impact assessments
• Organize, optimize and communicate progress toward completion of the overall reimbursement policy work portfolio
• Coordinate, collaborate and integrate input from various partners
• Analyze and monitor regulatory, industry, and market‑based trends

Strategic Advisor, Reimbursement Policy

• Serve as a senior-level individual contributor within the Pharmacy Analytics team
• Support the organization’s pharmacy strategy through advanced actuarial and analytical expertise
• Perform complex actuarial analyses, generating actionable insights
• Inform strategic decision-making to drive business outcomes
• Collaborate closely with cross-functional stakeholders and other actuarial teams
• Provide guidance and oversight to junior team members