E-Verify Program

Risk

• Lead the enterprise development of the Risk Adjustment strategy and operation
• Set and execute a multi-year Risk Adjustment strategy for Medicare Advantage and ACA Marketplace
• Serve as the executive subject matter expert on Risk Adjustment performance, risk score accuracy, and revenue impacts
• Lead all Risk Adjustment functions, including Provider documentation and coding strategy
• Collaborate closely with Quality Management/STARS team, Medical Management, Population Health, and Clinical Informatics
• Lead, mentor, and develop a high-performing Risk Adjustment team, fostering accountability, innovation, and continuous learning.

Assistant Vice President, Risk Adjustment

Director

• Establishes and operationalizes SIU strategic plan.
• Leads an organization that effectively identifies sources of FWA.
• Oversees the SIU staff comprised of analysts, investigators, nurses, and data analytics personnel.
• Creates an environment that assures full compliance with all legal and regulatory mandates.
• Maintains a comprehensive understanding of emerging and current FWA trends and schemes.
• Develops fraud detection analytics, including a comprehensive analytics process.

Director, Special Investigations Unit

Support Engineer

• Focused on getting the most value from our investment in Workday, this role is responsible for the HR technology configuration work of major projects that support Human Resources functions.
• Act as strategic HR technology consultant leading the alignment of HR technology solutions with business strategies, and identifying enterprise value from leveraging Workday.
• Partner with functional groups to communicate and clarify HR’s business needs, develop long-range technology plans for HR and act as liaison with IT to implement the solutions.
• Provide consultative support to assigned customers in defining or designing business processes and identifying enabling technologies based on customer requirements.
• Create, test, and support integrations using EIB, Studio, Core Connectors, APIs (REST/SOAP), RaaS, PECI, XML/XSLT.
• Partner with HR, Finance, Payroll, and IT teams to understand business needs and translate them into technical specifications.
• Resolve integration errors, monitor performance, and ensure data accuracy and security.
• Oversee the integration lifecycle, including deployments, system upgrades, and alignment with SDLC.
• Research, test, and implement new HR system capabilities; manage Workday updates and new feature adoption, including impact analysis, testing, and deployment.
• Develop and maintain documentation for configurations, integrations, and technical processes.
• Work with internal teams, vendors, and third parties to implement solutions.
• Act as a mentor to other team members, providing guidance and sharing HR functional and technical expertise.
• Perform system integration activities for projects (technical integration testing, assessments, etc.).
• Facilitate development of business solutions that combine knowledge of HR business processes, technological options, and process facilitation techniques.
• Serve as an information source concerning human resources technology needs for internal HR management and staff.

Principal Workday Technical Analyst

Systems Engineer

• Provide technical knowledge and support in operational system/application and procedural issues to the business and IT and help the business find technical solutions to meet their goals.
• Work in some phases of systems analysis and consider the business implications of the application of technology to the current business environment
• Provide ongoing user support for ad hoc questions, inquiries, and service requests.
• Provide timely and accurate reporting/data on inventory, productivity, user activity, and system performance on a regular and/or as requested basis.
• Resolve medium, moderately complex production issues.
• Troubleshoot and analyze to determine root cause of issues.
• Develop applicable business processes and solutions.
• Work collaboratively on projects and initiatives with the business and IT by eliciting and documenting business requirements and preparing appropriate functional specifications.

Business Systems Analyst

Strategy

• Shape Enterprise Strategy: Drive the development of forward-looking strategies that anticipate market trends, regulatory shifts, and evolving customer needs.
• Lead Strategic Initiatives: Own high-priority, cross-enterprise initiatives end-to-end—from problem framing through execution ensuring momentum, accountability, and delivery of outcomes.
• Deliver Executive-Level Insights: Translate complex data, analysis, and market intelligence into clear, compelling narratives and recommendations for senior leadership and the C-suite.
• Prepare Material and Present Regularly to Executives: Lead recurring and ad-hoc presentations to executives and governance forums, facilitating informed decision-making, alignment, and resolution of key tradeoffs.
• Influence and Align Stakeholders: Build consensus across senior leaders and external partners, ensuring alignment on priorities and execution plans.
• Guide Strategic Planning Cycles: Drive annual and multi-year planning processes, driving clarity and accountability across the enterprise.
• Ensure Measurable Impact: Define success metrics, track progress, and ensure strategic initiatives translate into tangible, enterprise-level results.
• Mentor and Develop Talent: Provide informal coaching and mentorship to junior team members, supporting skill development in problem-solving, executive communication, and strategic thinking.

Principal Strategic Advisor, Enterprise Strategy

Customer Support

• Develop and implement advanced strategies to enhance the Customer Experience Issue Management program
• Conduct thorough analysis of customer experience issues, identifying root causes and recommending actionable solutions
• Collaborate with various departments, including Risk, Compliance, Audit, and Business Partners
• Establish and monitor key performance indicators (KPIs)
• Engage with internal and external stakeholders
• Perform cost-benefit analyses
• Develop clear and concise communication plans
• Lead and mentor junior team members

Senior Strategic Advisor, Customer Experience

• Support Enterprise Strategy Development
• Drive Strategic Workstreams
• Develop Actionable Insights
• Prepare Executive Ready Materials
• Advance Initiative Progress
• Align Cross ‑Functional Stakeholders
• Translate Strategy into Execution
• Focus on Measurable Impact

Senior Strategic Advisor, Enterprise Strategy

Vice President

• Lead and mentor a team of fraud investigators, analysts, and other staff, providing guidance and support
• Collaborate internally with other departments to create and maintain a seamless claims payment integrity program.
• Work closely with analytics teams to contribute to the development of fraud detection strategies using data analytics, machine learning, and other advanced techniques
• Oversee the management of the SIU’s intake and investigative procedures
• Ensure all fraud investigation and prevention activities comply with state, federal, and industry regulations.

AVP, Special Investigations Unit

Therapist

• Provides psychological services to clients and their families/support systems in the clinical setting.
• Independently and interdependently conducts diagnostic evaluation, therapeutic intervention, education and referral.
• Facilitates collaboration between clients and the interdisciplinary team to respond to identified treatment needs.
• Performs evaluation/assessment and diagnosis.
• Creates team treatment plan and utilize various treatment modalities.
• Engages family when appropriate in the development of treatment plans.
• Reassesses and recommends changes to treatment plan when necessary.
• Communicates/notifies attending, supervising or referring provider of assessment and recommendations.
• Provides individual, family and group psychotherapy as identified in treatment plan.
• Coordinates treatment with other providers and community agencies.
• Completes treatment plan per department policy/procedure.
• Reassesses patient needs and progress per department policy/procedure.
• May provide crisis management in partnership with team.
• May have supervisory role in department.

Perinatal Psychologist – LICSW

• Perform initial clinical assessment
• Complete a diagnostic assessment that meets the requirements of regulatory agencies
• Reassess patient and progress in treatment
• Complete treatment plan per department process
• Provide individual, family and group therapy as identified by treatment plan
• Coordinate treatment with other community agencies/providers when appropriate

Licensed Therapist – Adult & Adolescent Partial and Day Program

Manager

• Manage the operational components of grantmaking while working as part of a larger team
• Provide leadership grounded in strategic and technical expertise
• Serve as the key point of contact and provide expert consultation on all technical, operational, and administrative grants-related issues
• Plan and execute the operational implementation of requests for services and funding opportunities
• Maintain a good overview of all grantmaking opportunities
• Serve as a subject matter expert for the Grant Management System (GMS)
• Provide coaching and training across the organization
• Lead internally and externally to promote equitable and exceptional experience for applicants and grantees
• Manage, refine, and execute processes related to grantmaking
• Develop and implement feedback loops and other learning practices
• Develop and coordinate grantee learning opportunities
• Monitor and assess grants management trends, data, research best practices
• Build internal buy-in and support for necessary changes

Grants Manager

Financial Planning and Analysis

• Track and manage rebate guarantees throughout the contract year.
• Perform client ASO rebate distribution calculations in accordance with contract terms.
• Monitor and analyze discount performance for ASO clients.
• Reconcile rebate and pricing guarantees to contractual commitments.
• Calculate program fees and communicate amounts to Finance for billing execution.
• Coordinate pharmacy commission payments.
• Tracking and management of ASO Pharmacy P&L.
• Support and manage development efforts related to the enhancement and maintenance of our current products and market offer components.
• Collaborate and execute critical activities such as strategic planning, complex financial/qualitative analysis and thought leadership at a departmental and enterprise level.
• Present information such as strategic concepts, planning data, and impact assessments to both internal and external audiences at all levels, including senior-level leadership.
• Organize, optimize and communicate progress towards the completion of overall work portfolio.
• Collaborate with and support other departments across the enterprise on both common initiatives and unique ventures, acting as a subject matter expert for healthcare delivery transformation and strategy.
• Utilize expertise to identify operational improvements with new analysis/reporting capabilities, project management techniques and/or consulting/engagement approaches.

Senior Strategic Advisor, ASO Pharmacy Financials

• Collaborate with and coordinate strategy, clinical, and analytics teams to identify, evaluate and implement medical cost management strategies to meet BCBSNC’s Medical Expense and Cost of Care goals.
• Drive execution of critical activities such as portfolio planning, program management, complex financial/qualitative analysis, and strategy implementation at a departmental and enterprise level.
• Present information such as portfolio and planning data/insights, risk impact assessments, and strategy performance metrics to audiences at all levels, including senior-level leadership.
• Organize, optimize and communicate progress towards the completion of overall work portfolio.
• Collaborate with and support other departments across the enterprise on both common initiatives and unique ventures, acting as a subject matter expert for medical cost management planning and execution.
• Identify, analyze and monitor internal and external risks and trends that affect timely execution and delivery of financial value.
• Utilize expertise to identify operational improvements with new analysis/reporting capabilities, project management techniques and/or consulting/engagement approaches.

Senior Strategic Advisor, Med Econ Planning – Enablement

• Exhibit strong functional/technical area knowledge of CareRadius configuration.
• Encompass SQL script building expertise.
• Provide advanced technical knowledge and support in system/application and procedural issues to the business and IT.
• Use judgment and initiative to review, analyze and develop solutions and applicable business processes for business systems while identifying and quantifying the business impact of those solutions to ensure quality, cost effectiveness, timeliness and customer service, including the resolution of large, complex production system problems.
• Provide systems analysis expertise and regularly considers the business implications of the application of technology to the current business environment.
• Coordinate ongoing user support for ad hoc questions, inquiries, and service requests.
• Ensure efficiency of reporting and data tools for supported business area use and for trend analysis.
• Coordinate the development of system support processes with IT; coordinate daily to resolve production support issues, including application failures and user errors; document, track and report all system support activities.
• Work collaboratively on projects and initiatives with the business and IT to test and implement long-term solutions by eliciting and documenting business requirements and preparing appropriate functional specifications while considering technical capabilities of the system/application and ensuring an integrated approach is used.
• Act as Business Lead/Coordinator on large, complex departmental and/or some corporate projects/initiatives.
• Facilitates project including intake, scheduling of projects, implementation, post-implementation support, and review and approve technical specifications.
• Serve as point of contact for business testing activities and influence testing strategy to ensure testing will appropriately meet business requirements.
• Analyze and verify results for accuracy, relevance and completeness. Provide impact assessments and make recommendations to the business owner regarding issues, risks, etc.
• Train/coach others on appropriate testing protocol, execution and test plan creation.
• Assist IT and help identify business area impacts for hardware and software upgrades, security changes, and architectural enhancements as needed.
• Configure and maintain critical system tables and data elements across multiple system environments.
• Analyze, develop and implement configuration changes to improve system performance and user efficiency.

Senior Business Systems Analyst

Communications

• Develop and execute clear, compelling communications strategies that prepare stakeholders for enterprise decisions and reinforce trust in organizational direction.
• Provide narrative leadership and contextual framing that helps audiences understand the “why” behind policies, products, and priorities.
• Ensure all communications connect to enterprise strategy, market realities, affordability priorities, and organizational purpose.
• Shape the internal and external environment to build trust, reinforce credibility, and reduce friction for business operations.
• Anticipate areas of sensitivity or risk and proactively prepare messaging that support safe, confident rollout of key initiatives.
• Translate policy, regulatory, and market insights into communications actions that strengthen the organization’s reputation and narrative authority.
• Connect dots across divisions, ensuring unified messaging and cohesive stakeholder preparation.
• Serve as an integrator who brings clarity and alignment among Brand, Performance Marketing and Corporate Social Responsibility teams.