Blue Cross and Blue Shield of North Carolina

Responsible for the development, maintenance, and ongoing improvement of the IT controls framework, including documentation, risk management, training, and associated processes. Provides oversight of the audit process within IT and the process for tracking open audit findings, te...

This role leads the development and implementation of comprehensive federal public affairs strategies to advocate for commercial and government insurance and healthcare delivery interests with legislative and executive branches and regulators. The advisor will also serve as the primary lobbyist and representative for Blue Cross NC with North Carolina state government branches and policy organizations.

This role supports the design, administration, and continuous improvement of employee benefit and wellness programs by analyzing costs, regulatory requirements, and market competitiveness. The analyst will also develop and deliver clear employee communications for various channels, including onboarding and annual open enrollment.

The Case Manager coordinates appropriate care, resources, and services for selected member populations, promoting effective utilization of healthcare resources to drive quality care. This involves serving on multidisciplinary teams, performing comprehensive assessments, and developing member-centric plans for treatment and discharge.

The role involves acting as a technical expert, leading the analysis, design, and development of high-volume, low-latency applications for mission-critical systems, while independently writing well-designed, testable, and efficient code. This position also requires providing technical leadership to specialists, understanding complex business problems, and evaluating solution buy vs. build recommendations for management.

This role provides advanced analytical and modeling expertise to support value-based care performance measurement and population risk normalization by applying risk models to member populations for accurate financial and quality measurement. The analyst will operationalize risk and actuarial methodologies to support total cost of care evaluation, reconciliation, forecasting, and provider settlement processes.

The Case Manager coordinates appropriate care, resources, and services for selected member populations, promoting effective utilization of health care resources to drive quality care. This involves serving on multidisciplinary teams, performing comprehensive assessments, developing member-centric plans, and monitoring progress across the continuum of care.

The Case Manager/Health Coach coordinates appropriate care, resources, and services for selected member populations, promoting effective utilization of health care resources to drive quality care. This involves serving on multidisciplinary teams, performing comprehensive assessments, and developing member-centric plans tailored to individual needs and barriers.

The Case Manager coordinates appropriate care, resources, and services for D-SNP member populations, promoting effective utilization of healthcare resources to drive quality care. This involves performing comprehensive assessments, developing member-centric plans, and performing ongoing monitoring and management of member progress.

This senior individual contributor role involves applying deep actuarial expertise and advanced analytical skills to shape and advance Pharmacy strategy, supporting critical actuarial functions and strategic decision-making. Responsibilities include leading complex actuarial modeling, assisting with pharmacy pricing for commercial segments, developing self-funded pricing models, and performing Pharmacy Trend analysis.