E-Verify Program

Strategy

• Support the implementation of healthcare redesign and partnership strategies to meet Blue Cross NC’s growth objectives
• Manage healthcare costs while improving outcomes and the healthcare experience for our members
• Assist with strategic planning, complex financial/qualitative analysis and thought leadership
• Present information on strategic concepts, planning data, medical expense/reimbursement rates, and provider performance metrics to internal and external audiences
• Organize and communicate progress towards completion of overall work portfolio
• Collaborate with and support departments across the enterprise
• Analyze and monitor industry, regulatory, technology and market-based trends that affect operations
• Support operational improvements with new analysis/reporting capabilities

Strategic Advisor, Healthcare

Software Engineer

• Responsible for leading small- to medium-scale, enterprise-wide Commercial Market development initiatives.
• Acts as a thought leader for the generation and refinement of Commercial Market Strategy & Innovation ideas and carries through from ideation to product design, requirements definition, execution, and launch to market.
• Supports the Commercial Market portfolio development efforts related to new market offer components.
• Develops ideas from inception, through the different staged gates of product development and delivery, to the market launch of the offering
• Collaborates with Strategic Advisors to evaluate market offer opportunities to determine impact on Commercial market
• Collaborate and execute critical activities such as complex financial/qualitative analysis and thought leadership at a departmental and enterprise level
• Facilitate communication and present information to both internal and external stakeholders at all levels, including senior-level leadership, to effectively drive programs/initiatives
• Assists in evaluating, as needed, strategic vendor partners to provide innovative and market differentiating capabilities and may participate in the assessment, selection, and contract negotiations of these partners/vendors
• Organize and communicate progress towards the completion of overall work portfolio
• Manages projects and cross-functional teams working on significant business strategies and opportunities
• Works cross-functionally across the enterprise to define and develop proof of concepts, business cases, designs, business requirements, and functional specifications for assigned strategic initiatives
• Supports the development of business cases in collaboration with strategic teams buy-in for the initiative and detail delivery components.
• Identifies and obtains leadership buy-in for the pricing strategy in collaboration with actuarial resources
• Collaborates on the marketing/launch strategy by providing key information and knowledge on the product/offer.
• Reviews and approves external literature, training material, requirements, functional specifications, and test plans and results

Commercial Markets Product Developer

IT Support

• Translate complex PBM contractual terms into robust financial/actuarial models, ensuring all contractual requirements are met or exceeded.
• Lead the setup and implementation of new, complex PBM arrangements.
• Perform detailed PBM rebate reconciliations, ensuring accuracy in financial forecasting and payment accuracy.
• Develop and maintain sophisticated models to forecast rebates, analyze pharmacy cost trends, and identify opportunities for savings.
• Work with key stakeholders (Pharmacy Operations, Finance, Legal) to align pharmacy strategy with broader health plan goals.
• Monitor industry news, regulatory changes, and competitive landscape to maintain a competitive position.
• Indirectly manage and mentor less senior actuarial team members, fostering growth in pharmacy financial acumen.

Principal Actuary – Pharmacy Benefit Manager Oversight

Manager

• Collaborate and engage with multiple internal stakeholders and external customers to implement population health management
• Assist in the development of operational strategies and innovative solutions
• Maintain awareness of trends, developments, and governmental regulations in managed health care organizations
• Manage the operational performance of multiple integrated clinical functions across multiple lines of business
• Collaborate and integrate with internal and external customers to deliver a fully integrated care delivery model
• Establish and monitor performance and production metrics and goals
• Responsible for the oversight, compliance, and execution of all regulatory or accreditation activities

Manager, Clinical Teams – Behavioral Health Utilization Management

Customer Support

• Perform basic scheduling and phone support with an emphasis on customer service to enhance the consumer experience
• Assist patients, clinical professionals and the general public with access to healthcare services
• Provides patient access to systemwide services
• Identifies need of customer by using active listen skills
• Assists patient, clinical professionals and the general public with access to health care services
• Performs scheduling and phone support with an emphasis on customer service to enhance the customer experience
• May assist customers with systemwide navigation
• May provide systemwide paging services
• Ensures data collection entries are accurate and complete
• Systemwide registration processes are consistently followed to ensure accuracy
• Utilizes various computer systems to perform scheduling and registration process including an electronic medical record
• May operate a multi-phone system

Customer Experience Representative

Actuary

• Accountable for completion of complex actuarial or analytical projects, ensuring timeliness, compliance, and quality of work
• Provide proactive and strategic thought leadership of ways to improve processes, reduce risks, and meet department and enterprise objectives to achieve profitable growth and/or improve value, quality, and access for Blue Cross NC customers
• Achieve segment financial targets and provide concise explanations of results and variances to expectations; act as a financial steward for the company
• Communicate effectively with all levels and divisions within the organization, including Divisional Leadership
• Manage external partnerships with vendors, auditors, regulators, and health care providers, including effective negotiation of contracts and/or rates
• Develop and maintain strong business relationships with internal partners through business expertise and exceptional support; act as a strategic advisor
• Meet continuing education standards required for job function, thought leadership and maintenance of actuarial credentials

Consulting Actuary – ACA Risk Adjustment

• Lead the planning, implementation, and optimization of performance media campaigns across various channels
• Manage and optimize paid media initiatives across Google marketing channels, including paid search (SEM), PMax, video, and display
• Develop and execute paid social strategies for various social media platforms, such as Meta and TikTok, to enhance our brand presence and drive conversions
• Oversee traditional media campaigns, including linear TV, out-of-home, and radio, to ensure an integrated marketing approach
• Collaborate closely with media agency partners to ensure campaign objectives are met and performance is maximized
• Utilize strong analytical skills to assess performance data and make proactive, informed recommendations for campaign optimization
• Work collaboratively with internal stakeholders to align media strategies with broader business objectives and marketing goals
• Monitor and report on campaign performance, providing insights and recommendations for improvement
• Stay current with industry trends, emerging technologies, and best practices in paid media marketing.

Performance Media Manager

• Performs actuarial research, experience studies, and statistical analyses and calculations using Excel, SQL, and SAS.
• Calculates premiums, risk scores, and reserves of new and existing plans of insurance.
• Provides support to senior analysts or actuaries as required.
• Retrieves and validates data for actuarial models.
• Builds model enhancements and determines reasons for changes to calculated factors.
• Analyzes impacts of changes to product lines and segments.
• Communicates filing status to internal stakeholders and transmits rate filings to regulatory agencies (NCDOI, CMS).
• Distributes established reports and responds to inquiries.
• Investigates trends and anomalies.
• Provides analytic support for corporate and departmental projects.

Actuarial Associate – Medicare Pricing

Administrative Assistant

• Perform administrative duties for one or more departments or units and provide various office support activities
• Support three separate leaders: 1) VP, Brand & Creative, 2) VP, Demand Generation, 3) VP, Strategy, Planning, Performance
• Support the leaders and department staff by scheduling, planning, and attending meetings as needed; provide administrative support including expense reporting and travel planning
• Act as a coordinator for departmental projects, following up on pending details, coordinating project activities, and ensuring deadlines are met
• Exercise considerable discretion and independent judgment while analyzing complex information requests and identifying trends or patterns
• Maintain and update distribution lists and organizational charts
• Coordinate departmental activities and events
• Coordinate departmental moves and serve as a liaison with IT for services, equipment, and system upgrades
• Assemble, analyze, and summarize information to support decision-making; prepare presentations, reports, summaries, and responses to inquiries using multiple information sources under general direction
• Support departmental budget processes, including running reports, basic budget analysis, and budget entries as needed

Senior Administrative Assistant, Specialist

Procurement

• Establish sourcing strategies for an assigned category(ies) in conjunction with internal stakeholders and their associated business strategy.
• Conduct sourcing events, including development of project work plan, category profile, category strategy, minimum requirements and evaluation criteria, solicitation.
• Develop and implement assorted bid documents and requests (i.e. RFP, RFI, RFQ); and manage status reporting and performance metrics of sourcing and category management activities.
• Understand, analyze and forecast complex market and industry dynamics and share subject matter expertise and industry knowledge within the established portfolio of products and services.
• Partner with stakeholders to source products and services using proven tools, processes, and analytics to drive and achieve business results.
• Evaluate analyses of sourcing results from a total cost of ownership perspective and provide optimization recommendations.
• Participate in cross-functional teams responsible for complex vendor negotiations, including those that require specialized subject matter expertise, nonstandard risk mitigation solutions, and coordination of multiple arrangements.
• Review and lead supplier relationship management and performance within an assigned category.
• Proactively establish and foster successful, positive working relationships with vendor personnel.
• Drive vendor engagement through formal and informal transactions.
• Engage stakeholders to implement and execute vendor relationship management plan.
• Coordinate and host vendor business reviews.
• Develop, track and manage yearly vendor plans for assigned vendors within the assigned category(ies) and ensure vendor compliance.
• Coordinate vendor risk assessments and develop plans to track and address significant risks.
• Serve as an escalation point for the business in resolving vendor performance issues.
• Manage contracts and collaborate effectively with Corporate Compliance, Legal, Audit and Risk Management and other internal stakeholders for compliance activities to ensure regulatory conditions are met.
• Research, analyze and provide data driven recommendations regarding compliance or audit level issue resolution and remediation.
• Facilitate and monitor vendor implementation of relevant corrective action plans.
• Develop new procedures, training, initiatives, specifications and recommendations for process or policy changes and improvements, as appropriate.

Senior Category Manager

Operations

• Lead end-to-end execution of value-based care programs, ensuring alignment between program requirements and operational delivery
• Drive execution across cross-functional teams, holding stakeholders accountable for delivery against defined timelines and objectives
• Identify and resolve operational barriers impacting program implementation and ongoing execution
• Establish and enforce operational workflows, governance, and accountability structures across programs
• Ensure operational readiness for new program implementations, contract changes, and model updates
• Oversee execution of initiatives designed to improve program delivery and provider engagement
• Partner with performance and analytics teams to translate insights into actionable operational changes
• Align operational processes with contractual requirements, measurement methodologies, and financial expectations
• Drive prioritization and sequencing of operational initiatives across enterprise stakeholders
• Serve as escalation point for complex operational issues impacting value-based care program execution
• Lead implementation of standardized processes supporting attribution, reporting inputs, and operational execution
• Provide clear updates to leadership on execution progress, risks, and mitigation actions
• Build and lead a team responsible for value-based care program operations and delivery

Director, Value Based Care Operations, Execution

Auditor

• Assist in planning and executing risk‑based audit and advisory engagements.
• Develop an understanding of payer‑specific risks, including regulatory compliance.
• Perform assigned audit procedures including walkthroughs, risk identification, and assessment.
• Support audits covering areas such as claims processing and utilization management.
• Prepare complete and accurate audit workpapers that support conclusions.
• Communicate professionally with business partners in a regulated environment.
• Assist in drafting clear, factual, and risk‑focused audit observations.
• Support tracking and validation of management action plans and corrective actions.

Business Process Auditor Associate

• Accountable for completion of complex actuarial or analytical projects, ensuring timeliness, compliance, and quality of work.
• Provide proactive and strategic thought leadership of ways to improve processes, reduce risks, and meet department and enterprise objectives.
• Achieve segment financial targets and provide concise explanations of results and variances to expectations.
• Communicate effectively with all levels and divisions within the organization, including Divisional Leadership.
• Manage external partnerships with vendors, auditors, regulators, and health care providers.
• Develop and maintain strong business relationships with internal partners through business expertise.

Consulting Actuary – Part D

• Actively contributes to the success of the Actuarial Services team.
• Responsible for handling highly complex actuarial modeling.
• Leads and/or provides consultative support to assigned projects and is viewed as an expert in the field.
• Assists in Rating/Pricing Develop/Maintain rating models.
• Perform Medical Trend analysis.
• Support Administrative Expense factor development.
• Conduct Experience Studies.
• Conduct Rating Factor Studies.
• Support Rate Filing development.
• Assists in support for Financial Forecasting.
• Works with FP&A to support development of Plan forecast for assigned segments.
• Assists in support for Network Management.
• Support evaluation of financial impacts of provider contract changes.
• Assists in support for Underwriting (all segments).
• Provide ad hoc support for underwriting requests.
• Assists in support for Sales and Marketing.
• Provide support for new product development.
• Provide support for new/existing product programs.
• Responsible for maintaining continuing education requirements as set by the appropriate Actuarial governing body (i.e. Society of Actuaries).
• Is a participant in good standing in the Actuarial Development Program, if still pursuing the FSA designation.

Principal Actuary

Program Manager

• Ensure operational deliverables are met on schedule and within scope
• Identify and resolve operational issues; escalate risks when necessary and maintain a formal escalation process
• Provide program subject matter expertise to implementation teams and operational stakeholders
• Manage program changes and risks; develop mitigation and contingency plans
• Develop and execute communication plans to ensure clarity and alignment across stakeholders
• Maintain strong relationships with provider partners and vendors by fostering trust, ensuring open communication, and aligning on program changes and deliverables
• Maintain a program playbook and implement process improvements for efficiency
• Lead implementation of new programs or major program changes when required
• Track stakeholder commitments and follow up to maintain accountability
• Analyze and develop business processes to improve operational efficiency
• Monitor program performance and report KPIs, benefit realization, and engagement metrics
• Work with provider vendors to optimize performance and maximize program impact
• Represent the organization in meetings with external parties, including consultants and vendors, and manage vendor service delivery as needed
• Support contract and financial oversight, including performance guarantees, vendor invoicing, and develop/tracking budgets, operating plans, and financial forecasts
• Apply strategic thinking to balance competing priorities and align program decisions with business objectives