Blue Cross and Blue Shield of Kansas

Role Description The Clinical Quality Nurse Consultant serves as a clinical liaison between Blue Cross Blue Shield of Kansas (BCBSKS), providers, and members to support quality improvement, care coordination, and value-based care initiatives across all lines of business. This role partners with providers and internal teams to implement data-informed clinical processes, improve quality outcomes, and support regulatory and accreditation requirements. The Nurse Consultant provides clinical expertise in quality measurement, HEDIS performance, and care coordination while advancing organizational goals related to quality, affordability, and member experience. This position reports to the Manager, Clinical Quality & Accreditation. This position is eligible to work remotely, hybrid or onsite in accordance with our Telecommuting Policy. Applicants must reside in Kansas or Missouri or be willing to relocate as a condition of employment. What you’ll do - Support clinical quality improvement and value-based care initiatives by partnering with providers and internal teams to improve quality outcomes across assigned populations and lines of business. - Provide clinical expertise related to quality measurement, including HEDIS metrics, care coordination strategies, and performance improvement activities. - Collaborate with provider offices to implement workflows, tools, and processes that support population health management, care coordination, and quality gap closure. - Participate in quality oversight activities, including medical record reviews and peer review processes, serving as a clinical resource for committees such as the Administrative Quality Committee (AQC) as assigned. - Prepare and contribute to quality reports, summaries, and presentations supporting departmental, divisional, and corporate quality objectives. - Collaborate with cross-functional teams to identify trends, opportunities, and educational needs related to quality measurement and clinical performance. - Support compliance with applicable regulatory and accreditation standards as part of routine clinical quality activities. - Serve as a clinical resource for internal staff, providers, and external partners related to quality improvement programs and care coordination solutions. - Contribute to the development and maintenance of policies, procedures, and training materials supporting clinical quality improvement and reporting activities. Qualifications - Strong clinical knowledge and understanding of quality improvement principles and healthcare delivery systems. - Ability to communicate effectively with providers, internal stakeholders, and external partners. - Ability to work independently, prioritize work, and adapt to changing priorities. - Ability to analyze clinical information and identify trends or improvement opportunities. - Working knowledge of provider practice patterns, utilization, and care coordination models. - Understanding of business continuity and departmental recovery expectations. Requirements - Associate Degree in Nursing (ADN) required. Bachelor’s in nursing or health related field preferred. - Current unrestricted Kansas Registered Nurse (RN) licensure required. - Minimum of 5 years of RN clinical experience required. - Minimum 3 years' experience in clinical quality improvement or quality measurement activities, preferred. - Certified Professional Coder (CPC) certification required within two years of hire. - Ability to sit or stand for extended periods. - Ability to look at a computer screen for prolonged periods. - Occasional walking, bending, or reaching within the office environment. - Ability to lift and carry up to 15 pounds. Compensation $73,920 - $92,400 annually Exempt Grade 15 Blue Cross and Blue Shield of Kansas offers excellent competitive compensation with the goal of retaining and growing talented team members. The compensation range for this role is a good faith estimate, it is estimated based on what a successful candidate might be paid. All offers presented to candidates are carefully reviewed to ensure fair, equitable pay by offering competitive wages that align with the individual's skills, education, experience, and training. The range may vary above or below the stated amounts. Our Commitment to Connection and Belonging At Blue Cross and Blue Shield of Kansas, we are committed to fostering a culture of connection and belonging, where mutual respect is at the foundation of our workplace. We provide equal employment opportunities to all individuals, regardless of race, color, religion, belief, sex, pregnancy (including childbirth, lactation, and related medical conditions), national origin, age, physical or mental disability, marital status, sexual orientation, gender identity, gender expression, genetic information (including characteristics and testing), military or veteran status, family or parental status, or any other characteristic protected by applicable law. Blue Cross and Blue Shield of Kansas conducts pre-employment drug screening, criminal conviction check, employment verifications and education as part of a conditional offer of employment.

Role Description The Solutions Architect is responsible for designing and implementing scalable, secure, and cost-effective technology solutions for BCBSKS. This position collaborates closely with business stakeholders, development teams, and external vendors to translate complex requirements into actionable architectural designs, ensuring the successful delivery of solutions across various platforms. Your technical expertise, combined with your ability to communicate complex concepts clearly, will help drive innovation and efficiency in our organization. As a Solutions Architect, you will lead the architectural design process, ensure alignment with industry’s best practices, and contribute to the continuous improvement of our technical landscape. This position is eligible to work remotely, hybrid or onsite in accordance with our Telecommuting Policy. Applicants must reside in Kansas or Missouri or be willing to relocate as a condition of employment. What you’ll do - Solution Design: Collaborate with business stakeholders to understand requirements and design end-to-end solutions that meet both functional and technical specifications. - Architecture Leadership: Lead the development of architectural frameworks and principles that ensure scalability, security, and performance in complex environments. - Technical Expertise: Provide deep technical knowledge in areas such as cloud architecture, software development, data management, and integration, ensuring alignment with business objectives. Identify appropriate cloud-based tools and frameworks based on use case requirements. - Stakeholder Engagement: Work closely with business leaders, product managers, and technical teams to translate business needs into actionable technology solutions. - Collaboration with Teams: Work with cross-functional teams, including developers, operations, and security experts, to implement solutions and troubleshoot any issues that arise during the development and deployment stages. - Cost and Risk Management: Design cost-effective solutions while ensuring the minimization of technical risks. Evaluate trade-offs and recommend alternative approaches when necessary. Identify cost management strategies to maximize resource utilization while minimizing unnecessary expenditures. - Documentation: Create and maintain clear documentation for architectural designs, decisions, and best practices to support ongoing development and knowledge sharing. - Continuous Improvement: Stay up to date with industry trends, emerging technologies, and best practices to continuously improve the company’s architecture and solution delivery. - Client and Vendor Interaction: Interface with external clients and third-party vendors to ensure that solutions align with both client expectations and vendor capabilities. - Implementation and Integration: Oversee infrastructure implementations/integrations (on-prem, cloud, PaaS, etc.), providing guidance and support to ensure minimal disruption and a seamless transition. Qualifications - Experience with at least one of the major cloud platforms (AWS, Microsoft Azure, Google Cloud). - Preferable experience with cloud and Azure. - Knowledge of programming languages such as C#, Java, Python, or similar. - Expertise in infrastructure technologies, including networking, servers, storage, and virtualization (VMware, Docker, Kubernetes). - Experience with SQL and NoSQL databases (e.g., DB2, MySQL, PostgreSQL, MongoDB, Cassandra). - Understanding of security best practices and tools, including encryption, IAM (Identity and Access Management), and compliance frameworks. - Broad knowledge of security technologies and controls such as Security Information and Event Management (SIEM) systems, intrusion detection/prevention systems (IDS/IPS), public key infrastructure (PKI), antivirus, firewalls, and endpoint security. - Understanding of DevOps practices and CI/CD pipelines is a plus. Requirements - High school diploma or equivalent required. - Bachelor’s degree in computer science, information technology or related field preferred. In lieu of degree, an additional 4 years’ progressive, relevant experience within direct or related field required. - Minimum 6 years’ experience in IT, application development, or related field. - Minimum 2 years’ experience in a leadership or senior level role. - Relevant cloud certification preferred (i.e., AWS Certified Solutions Architect (Professional), Microsoft Certified: Azure Solutions Architect Expert, or Google Professional Cloud Architect). - Previous healthcare experience preferred. Benefits - Base compensation is only one component of your competitive Total Rewards package. - Incentive pay program (EPIP). - Health/Vision/Dental insurance. - 6 weeks paid parental leave for new mothers and fathers. - Fertility/Adoption assistance. - 2 weeks paid caregiver leave. - 401(k) plan matching up to 5%. - Tuition reimbursement. - Health & fitness benefits, discounts and resources. Compensation $125,600 - $157,000 Blue Cross and Blue Shield of Kansas offers excellent competitive compensation with the goal of retaining and growing talented team members. The compensation range for this role is a good faith estimate, it is estimated based on what a successful candidate might be paid. All offers presented to candidates are carefully reviewed to ensure fair, equitable pay by offering competitive wages that align with the individual's skills, education, experience, and training. The range may vary above or below the stated amounts. Our Commitment to Connection and Belonging At Blue Cross and Blue Shield of Kansas, we are committed to fostering a culture of connection and belonging, where mutual respect is at the foundation of our workplace. We provide equal employment opportunities to all individuals, regardless of race, color, religion, belief, sex, pregnancy (including childbirth, lactation, and related medical conditions), national origin, age, physical or mental disability, marital status, sexual orientation, gender identity, gender expression, genetic information (including characteristics and testing), military or veteran status, family or parental status, or any other characteristic protected by applicable law. Blue Cross and Blue Shield of Kansas conducts pre-employment drug screening, criminal conviction check, employment verifications and education as part of a conditional offer of employment.

Role Description The Manager of Application Development leads a team of developers and technical professionals responsible for designing, developing, and supporting enterprise applications in a dynamic health insurance environment. This role ensures alignment with strategic business objectives, technology standards, and compliance requirements. The manager partners with business units, product teams, and IT leadership to deliver secure, scalable, and innovative solutions that improve member and provider experiences. This position is eligible to work remotely, hybrid or onsite in accordance with our Telecommuting Policy. What you’ll do - Oversee full software development lifecycle (SDLC) for health insurance systems, including enrollment, claims, provider networks, and customer portals. - Lead application modernization efforts, including cloud migration or refactoring monolithic systems into microservices. - Collaborate with business and product teams to understand requirements and translate them into technical solutions. - Ensure adherence to regulatory and security standards (e.g., HIPAA, HITRUST). - Drive adoption of best practices in coding, testing, DevOps, and Agile delivery. - Manage resource allocation, project timelines, and development budgets. - Evaluate and implement new tools, technologies, and architectures to optimize application performance. - Coordinate with infrastructure, data, and cybersecurity teams to ensure system integrity and scalability. - Resolve complex technical issues and lead root cause analysis to prevent recurrence. - Regularly influence, update and report to senior IT leadership and business stakeholders; influence cross-functional stakeholders, including product, compliance, and operations teams. - Accountable for performance monitoring, policy enforcement, termination process, disciplinary action, hiring, compliance and team development. Maintaining accurate records of all hiring, firing and disciplinary action. Qualifications - Strong understanding of healthcare systems and regulatory compliance (HIPAA, CMS, etc.). - Proficiency in modern development frameworks (e.g., .NET, Java, Angular, React) and database technologies (SQL, NoSQL). - Experience with API integration, microservices, and cloud platforms (e.g., Azure, AWS). - Demonstrated leadership in Agile methodologies, including Scrum or SAFe. - Ability to manage multiple projects and prioritize in a fast-paced environment. - Strong analytical skills to drive data-based decision-making, problem-solving and critical-thinking with a solution-oriented mindset and focus on business outcomes. - Effective communication and interpersonal skills across technical and non-technical audiences. - Experience in application security and vulnerability remediation. - Familiarity with DevOps tools (CI/CD pipelines, source control, automated testing). - Business acumen in payer operations such as claims processing, EDI, or member engagement systems. Requirements - Bachelor’s degree in Computer Science, Information Systems, or related field preferred. - Requires at least 10 years of experience in Information Technology and Services. At least 7 years of this experience must have been within Application Development and Support and three years of this experience must have been in a supervisory position. - Experience in the health insurance or healthcare technology sector is strongly preferred. - Demonstrated experience leading large-scale digital transformation initiatives and enterprise modernization programs is preferred. - Experience modernizing enterprise platforms such as Salesforce, Pega, SAP, or other enterprise SaaS/commercial platforms is preferred. - Product management or product-oriented technology leadership experience is preferred. - Experience working in startup, innovation, or high-growth environments with a strong bias for action, rapid execution, and continuous learning is preferred. - Experience leading cross-functional teams through organizational change, technology transformation, and modernization initiatives is highly desirable. - Experience leveraging Artificial Intelligence, automation, and modern software engineering practices to improve developer productivity, accelerate software delivery, and drive business outcomes is preferred. Physical Requirements - Must be able to lift to 15 pounds at times (e.g., laptop, equipment). - Prolonged periods of sitting at a desk and working on a computer. Compensation $135,440 - $169,300 Exempt Grade 19 Blue Cross and Blue Shield of Kansas offers excellent competitive compensation with the goal of retaining and growing talented team members. The compensation range for this role is a good faith estimate, it is estimated based on what a successful candidate might be paid. All offers presented to candidates are carefully reviewed to ensure fair, equitable pay by offering competitive wages that align with the individual's skills, education, experience, and training. The range may vary above or below the stated amounts. Our Commitment to Connection and Belonging At Blue Cross and Blue Shield of Kansas, we are committed to fostering a culture of connection and belonging, where mutual respect is at the foundation of our workplace. We provide equal employment opportunities to all individuals, regardless of race, color, religion, belief, sex, pregnancy (including childbirth, lactation, and related medical conditions), national origin, age, physical or mental disability, marital status, sexual orientation, gender identity, gender expression, genetic information (including characteristics and testing), military or veteran status, family or parental status, or any other characteristic protected by applicable law. Blue Cross and Blue Shield of Kansas conducts pre-employment drug screening, criminal conviction check, employment verifications and education as part of a conditional offer of employment.

Role Description Claims System Specialist will research problems in the Adjudication and Claim Entry System (ACES) as reported by ACES users and document problems in SBM. Develop, document, test, and approve system modifications, in tandem with Information Technology & Services (IT&S) staff, in ACES needed to resolve problems or develop new functionality. Maintain system security within ACES. Act as a liaison between IT&S and ACES users. This position is eligible to work remotely, hybrid, or onsite in accordance with our Telecommuting Policy. Applicants must reside in Kansas or Missouri or be willing to relocate as a condition of employment. Responsibilities - System Management and Support: - Maintain, update, and troubleshoot healthcare systems related to the claims programs and peripheral systems such as membership, BGT, Provider, etc. - Ensure data integrity and accuracy in claims processing and eligibility systems. - Coordinate with IT and operational teams to resolve system issues and ensure seamless functionality. - Project Management: - Participate in system upgrade projects, implementing new functionalities and enhancements to support BCBSKS operations. - Work with cross-functional teams, including developers, analysts, and business leaders, to ensure project deliverables are met. - Assist in the development of project plans, timelines, and documentation for system improvements. - Claims and Eligibility System Support: - Collaborate with claims and eligibility teams to identify system needs and ensure efficient processing of claims. - Conduct testing and validation of system changes to ensure they align with guidelines and standards. - Develop and update workflows to enhance system capabilities for claims processing. - Develop and document needed business requirements to modify the existing ACES system, either to correct a problem or implement new functionality, and effectively communicate those requirements to IT&S staff. - Data Analysis and Reporting: - Analyze healthcare data from the system to identify trends, issues, and opportunities for improvement. - Generate regular and ad-hoc reports to support decision-making by management. - Monitor system performance and produce detailed analysis for system audits or compliance checks. - Write and execute queries in QMF (mainframe) or QMF for Workstation or other SQL-based tools or applications to identify problems and/or test claim situations. - Customer Support and Training: - Provide technical assistance to internal teams and users on system functionalities. - Train staff on the use of new or updated system features related to the programs. - Assist in creating user manuals, guidelines, and training materials for healthcare system applications. - Maintain ACES user specific security settings as the ACES system administrator. - Compliance and Regulations: - Ensure systems comply with federal healthcare regulations and data privacy laws (e.g., HIPAA). - Stay up to date with FEP/ITS and local guidelines and health plan requirements, ensuring system modifications adhere to these standards. - Perform and coordinate BCBSA partner plan testing requirements with other Blue Cross and Blue Shield plans for ITS system changes as assigned by management. - As assigned by management, serve as primary point of contact for Blue Cross and Blue Shield partner plans. - Determine how to implement and integrate new ITS products pertaining to ACES. - Collaboration and Communication: - Serve as a liaison between IT and operations teams, ensuring smooth communication and system functionality across departments. - Communicate system issues and updates to key stakeholders in a timely manner. - Serve as an ACES system expert to all employees of the company and research and resolve all questions submitted by fellow employees. - Represent the Claims area in company meetings with all levels of employees, in a professional manner, as a subject matter expert. Qualifications - Experience or knowledge in data processing techniques is preferred but not required. - Must be organized, detail oriented and be able to prioritize and work on multiple different topics within any one given day. - Existing ability to use QMF is preferred, but not required. - Existing ability to use Rally for user story documentation is preferred. - Existing ability to use QA Complete for test case documentation is preferred. - Existing knowledge of MTM, FEP PIP, LDLA, BlueCard Scorecard and State of Kansas Performance Guarantees for claims transactions is preferred. - Existing knowledge of peripheral systems such as Membership, Provider, BGT, Prime, FEP, ITS, ICD Enterprise Database, etc., is preferred but not required. - Existing knowledge of the accumulator integration processes with Prime and Caremark is preferred, but not required. Requirements - High school graduate or equivalent required. - Bachelor's degree with emphasis in Computer Science, Business Administration, or Accounting is preferred. - Must have 1 year experience in Blue Cross and Blue Shield of Kansas claims processing with a thorough knowledge of the existing ACES system. - Experience using the principles of system testing is preferred. - Training to adjudicate claims on multiple lines of business is preferred. Benefits - Base compensation is only one component of your competitive Total Rewards package. - Incentive pay program (EPIP). - Health/Vision/Dental insurance. - 6 weeks paid parental leave for new mothers and fathers. - Fertility/Adoption assistance. - 2 weeks paid caregiver leave. - 401(k) plan matching up to 5%. - Tuition reimbursement. - Health & fitness benefits, discounts and resources.

Role Description The RPA Solution Designer serves as the technical leader and point of contact for the Robotic Process Automation (RPA) team, responsible for designing and evolving RPA technology. This position is responsible for designing scalable, secure, and resilient RPA solutions that integrate with legacy systems, modern platforms, and cloud environments. Additionally, this position leads the evaluation and adoption of emerging technologies such as artificial intelligence (AI), machine learning (ML), process/task mining, intelligent document processing (IDP), and agents to enhance RPA capabilities. This position reports to the Manager, Robotic Process Automation. This position is eligible to work remote, hybrid or onsite in accordance with our Telecommuting Policy. Applicants must reside in Kansas or Missouri or be willing to relocate as a condition of employment. What you’ll do - Define and maintain RPA solutions by ensuring designs align with IT, RPA, and business strategy and goals. - Manage RPA-specific applications by setting up and maintaining bot profiles, machines, and licenses, serving as the primary technical contact with systems administrators for RPA servers. - Design and implement scalable, future-ready automation frameworks, reusable components, and governance models that ensure long-term sustainability and maintainability of solutions within RPA. - Establish and document design standards, coding best practices, and guidelines for consistent, high-quality automation development and deployment of solutions within RPA. - Provide technical leadership through code reviews, ensuring quality, security, and alignment across all departmental initiatives. - Identify, evaluate, and optimize automation solutions, orchestration tools, and AI/ML integrations like natural language processing (NLP), optical character recognition (OCR), and IDP to enhance capabilities within RPA. - Lead proofs of concepts for emerging technologies, serving as the primary point of contact, continuous learner, and advocate for innovation, readiness, and adoption within RPA. - Collaborate cross-functionally with several business units and external partners to translate automation capabilities into effective technical solutions and clearly communicate bot, agent, and human interactions. - Ensure all automation solutions adhere to enterprise security, privacy, and regulatory requirements in partnership with IT&S, Security, and Compliance teams. - Partner with Information Technology and Services to drive optimal use of RPA systems and software, ensuring automation solutions integrate seamlessly with application programming interfaces (APIs), databases, and cloud services. - Mentor developers and technical team members, fostering a culture of technical excellence, continuous learning, and innovation in automation design and delivery. Qualifications - High school diploma or equivalent required. - Bachelor’s degree in computer science, engineering, or related field of study preferred. - Master’s degree highly preferred. - In lieu of degree, an additional 3 years’ relevant experience required. - Minimum of 8 years’ working experience in automation, software engineering, or development. Healthcare/Payer experience preferred. - Minimum of 2+ years of experience with automation solution design, project leadership, and development preferred. - UiPath professional certifications required within six months of hire, with re-certification as needed to maintain active credential status. Requirements - Deep expertise in intelligent automation technologies with the ability to align automation solutions to business goals, compliance standards, and governance. - Deep expertise in RPA automation platform and infrastructure (e.g., UiPath). - Strong understanding of automation design patterns, exception handling, and bot orchestration. - Experience integrating automation software with APIs, databases, and enterprise systems. - Strong understanding of software/application development and deployment methodologies (DevOps, Agile, Git, CI/CD) for effective management of automations, documentation, and processes. - Familiarity with AI/ML, OCR, NLP, and intelligent document processing tools. - Strong understanding and use of system diagrams, data modelling, artifacts, and other SDLC tools and documentation. - Knowledge of cloud platforms (Azure, AWS) and hybrid automation deployments. - Strong grasp of security, compliance, and data governance in intelligent automation. - Excellent communication and stakeholder management skills. - Proven ability to lead cross-functional teams and drive automation strategy and deployment within RPA. Benefits - Base compensation is only one component of your competitive Total Rewards package. - Incentive pay program (EPIP). - Health/Vision/Dental insurance. - 6 weeks paid parental leave for new mothers and fathers. - Fertility/Adoption assistance. - 2 weeks paid caregiver leave. - 401(k) plan matching up to 5%. - Tuition reimbursement. - Health & fitness benefits, discounts and resources. Compensation $125,600 - $157,000. Exempt Grade IT&S 18. Blue Cross and Blue Shield of Kansas offers excellent competitive compensation with the goal of retaining and growing talented team members. The compensation range for this role is a good faith estimate, it is estimated based on what a successful candidate might be paid. All offers presented to candidates are carefully reviewed to ensure fair, equitable pay by offering competitive wages that align with the individual's skills, education, experience, and training. The range may vary above or below the stated amounts. Our Commitment to Connection and Belonging At Blue Cross and Blue Shield of Kansas, we are committed to fostering a culture of connection and belonging, where mutual respect is at the foundation of our workplace. We provide equal employment opportunities to all individuals, regardless of race, color, religion, belief, sex, pregnancy (including childbirth, lactation, and related medical conditions), national origin, age, physical or mental disability, marital status, sexual orientation, gender identity, gender expression, genetic information (including characteristics and testing), military or veteran status, family or parental status, or any other characteristic protected by applicable law. Blue Cross and Blue Shield of Kansas conducts pre-employment drug screening, criminal conviction check, employment verifications and education as part of a conditional offer of employment.

Role Description The Group Rating Associate is responsible for executing accurate and timely rating for employer group renewals and retrospective reviews. This role performs monthly production rating, tracks and monitors data, and maintains record retention in compliance with regulatory and corporate requirements. The Group Rating Associate works closely with the Team Lead Group Rating Workflow, to ensure rating accuracy and workflow efficiency while supporting the Underwriting teams and Sales options. This position is eligible to work remote, hybrid or onsite in accordance with our Telecommuting Policy. Applicants must reside in Kansas or Missouri or be willing to relocate as a condition of employment. What you’ll do - Conduct production rating for employer group renewals ensuring accuracy and compliance with rating methodologies. - Assist in the quality review of production rating, ensuring accuracy and adherence to established guidelines. - Process Group Rating Information Tracker (GRIT) requests from Sales for small group rating options. - Rotate monthly duties, including creating, monitoring, and processing production work to meet deadlines. - Track and maintain records of prospects, contracts, concessions, and other key reports to ensure accurate documentation. - Assist in purging and maintaining record retention processes for compliance and audit purposes. - Provide support to Sales by responding to inquiries and assisting in group renewal options and reporting. - Collaborate with Underwriting and Sales teams to ensure smooth execution of rating processes and timely delivery of reports. Qualifications - Three years’ experience related to rating, finance, statistics or computer science; OR 12 hours college math (to include College Algebra or higher) or computer applications/programming. - Bachelor's degree in Business, Mathematics, Finance, or a related field preferred. - Experience supporting Sales teams or Underwriting in a rating or pricing capacity preferred. - Familiarity with rating methodologies, contract facilitation, and regulatory compliance preferred. Requirements - Strong analytical and problem-solving skills to ensure accuracy in rating and financial assessments. - Detail-oriented with the ability to conduct quality checks and maintain rating consistency. - Excellent communication skills to collaborate effectively with Sales, Membership and other UW teams. - Strong organizational skills to track and manage multiple rating tasks and priorities. - Knowledge of rating methodologies for self-funded and fully insured plans preferred. - Ability to work efficiently in a team-oriented environment with changing priorities. - Proficiency in Microsoft Office applications (Excel, Word, Outlook, Teams) and Underwriting systems. - Proficiency in data entry, tracking renewals, and maintaining compliance with regulatory requirements. - Experience in record retention and document management processes preferred. Benefits - Base compensation is only one component of your competitive Total Rewards package. - Incentive pay program (EPIP). - Health/Vision/Dental insurance. - 6 weeks paid parental leave for new mothers and fathers. - Fertility/Adoption assistance. - 2 weeks paid caregiver leave. - 401(k) plan matching up to 5%. - Tuition reimbursement. - Health & fitness benefits, discounts and resources. Compensation $27.08 - $33.80 Non-exempt Grade 13 Blue Cross and Blue Shield of Kansas offers excellent competitive compensation with the goal of retaining and growing talented team members. The compensation range for this role is a good faith estimate, it is estimated based on what a successful candidate might be paid. All offers presented to candidates are carefully reviewed to ensure fair, equitable pay by offering competitive wages that align with the individual's skills, education, experience, and training. The range may vary above or below the stated amounts. Our Commitment to Connection and Belonging At Blue Cross and Blue Shield of Kansas, we are committed to fostering a culture of connection and belonging, where mutual respect is at the foundation of our workplace. We provide equal employment opportunities to all individuals, regardless of race, color, religion, belief, sex, pregnancy (including childbirth, lactation, and related medical conditions), national origin, age, physical or mental disability, marital status, sexual orientation, gender identity, gender expression, genetic information (including characteristics and testing), military or veteran status, family or parental status, or any other characteristic protected by applicable law. Blue Cross and Blue Shield of Kansas conducts pre-employment drug screening, criminal conviction check, employment verifications and education as part of a conditional offer of employment.

Role Description Under the direction of the Supervisor, Risk Adjustment Coding and Outreach, this position will be responsible for the ICD-10-CM diagnosis code capture for Affordable Care Act (ACA) and Medicare Risk Adjustment initiatives to include CMS required Medicare and Commercial Risk Adjustment and Risk Adjustment Data Validation (RADV) audits. The responsibilities of this position significantly impact the company's risk adjustment revenue opportunities. This position will retrieve, review, and analyze medical records for documentation to substantiate the medical diagnosis codes submitted on claims. Activities also include member and provider communication and education, scheduling, and process performance measurement to support closing both risk adjustment and quality care gaps. This position is in a fast-paced, developing area. This position is eligible to work remote, hybrid or onsite in accordance with our Telecommuting Policy. Applicants must reside in Kansas or Missouri or be willing to relocate as a condition of employment. What you’ll do - Ensures compliance with all applicable Federal laws and regulations related to coding and documentation guidelines for Commercial and Medicare Risk Adjustment Payment System. - Performs medical record review to capture all relevant diagnosis codes included in the CMS and HHS Hierarchical Condition Categories (HCC) conditions for Commercial and Medicare Risk Adjustment Payment system. - Abstract diagnostic data and properly assign ICD-10-CM codes for both health Hierarchical Condition Categories (HCC) and Rx HCCs that map to a Risk Adjusted HCC ensuring the documentation meets all CMS standard requirements for valid HCC Submission. - Selects and accurately records all appropriate records and data on assigned chart abstraction projects. - Utilize medical coding software programs to abstract, analyze, and/or evaluate clinic documentation and enter diagnosis codes. - Comply with national standards and coding practices set by the ICD-10-CM coding guidelines for accuracy, and compliance with Risk adjustment production standards. - Must meet 95% coding accuracy within 6 months and maintain accuracy in conjunction with department coding production guidelines. - Research and review provider submitted claims through Imaging resources. - Ability to learn and understand Natural Language Processing software (NLP). Qualifications - High school diploma or equivalent is required. - AAPC or AHIMA coding certification required. - Risk adjustment HCC coding experience is preferred. - One year of experience to include coding, billing, claims auditing. Requirements - Extensive knowledge of ICD-10CM coding guidelines. - Ability to consistently meet established minimum coding quality standards in a production environment. - Ability to assimilate and adapt quickly and accurately to coding guideline and/or other job-related changes. - Requires close attention to detail, strong grammar and reading comprehension skills, along with strong critical thinking and problem-solving skills. - Ability to work independently with minimum supervision, excellent reliability, and demonstrated ability to work timely and effectively under strict deadlines. - Make recommendations for process improvements to further enhance coding quality and outcomes. - Complies with policies and procedures for confidentiality of all patient records and security of systems as required by HIPAA Privacy regulations. - Responsible for continuous improvement and ensuring a high level of accuracy on internal chart audits. Compensation $27.08 - $33.80 Non-exempt Grade 13 Blue Cross and Blue Shield of Kansas offers excellent competitive compensation with the goal of retaining and growing talented team members. The compensation range for this role is a good faith estimate, it is estimated based on what a successful candidate might be paid. All offers presented to candidates are carefully reviewed to ensure fair, equitable pay by offering competitive wages that align with the individual's skills, education, experience, and training. The range may vary above or below the stated amounts. Benefits - Base compensation is only one component of your competitive Total Rewards package. - Incentive pay program (EPIP). - Health/Vision/Dental insurance. - 6 weeks paid parental leave for new mothers and fathers. - Fertility/Adoption assistance. - 2 weeks paid caregiver leave. - 401(k) plan matching up to 5%. - Tuition reimbursement. - Health & fitness benefits, discounts and resources.

Role Description The Supervisor Group Rating oversees the Group Rating Analysts, ensuring accuracy, efficiency, and adherence to rating guidelines. This role is responsible for overseeing daily rating operations, supporting workflow management, training team members, and assisting with reporting and analysis. The Supervisor serves as a key liaison between Group Rating and internal stakeholders, supporting efficiency efforts, reviewing special rating situations, and maintaining compliance with regulatory requirements. This position is eligible to work remote, hybrid or onsite in accordance with our Telecommuting Policy. Applicants must reside in Kansas or Missouri or be willing to relocate as a condition of employment. What you’ll do - Oversee Group Rating Analysts, ensuring quality control, workflow management, and employee development, including hiring, training, and performance management. - Oversee daily group rating activities, including reviewing and approving special rating situations to maintain accuracy and competitiveness. - Serve as a liaison between the Group Rating team and internal stakeholders, including Sales, Actuarial, and Underwriting, to facilitate effective communication and decision-making. - Support the automation and streamlining of rating processes, collaborating with the Quality & Systems team to enhance efficiency and reduce manual work. - Assist in developing and maintaining training materials and procedural documentation related to rating methodologies. - Conduct training sessions for Sales, Underwriting, and other departments to improve understanding of rating policies and processes. - Assist with concession analysis and reporting to provide insights on rating impacts and pricing trends. - Support the preparation and review of rate exhibits, ensuring alignment with financial and regulatory requirements. - Monitor market trends and collaborate with leadership to recommend process improvements in rating methodologies. - Ensure compliance with federal and state regulations, including ERISA and ACA, within rating activities. Qualifications - Bachelor's degree in Mathematics, Statistics, Actuarial Science, Business, or a related field. - Minimum of four years of experience in group rating, underwriting, or actuarial work in the health insurance industry. - Experience with health insurance contracts, rating systems, and alternative funding arrangements. - Prior leadership or supervisory experience preferred. Requirements - Strong interpersonal skills to effectively collaborate with internal teams and leadership. - Excellent communication skills to explain rating methodologies and complex data to non-technical stakeholders. - Strong analytical and problem-solving abilities to assess trends, identify process improvements, and support rating decisions. - Knowledge of health insurance rating techniques, underwriting principles, and actuarial methodologies. - Familiarity with regulatory compliance requirements, including ERISA and ACA. - Ability to manage multiple priorities, track deadlines, and ensure workflow efficiency. - Strong leadership skills to guide, train, and develop employees in a team-oriented environment. - Proficiency in reviewing, interpreting, and applying rating policies and procedures. Benefits - Base compensation is only one component of your competitive Total Rewards package. - Incentive pay program (EPIP). - Health/Vision/Dental insurance. - 6 weeks paid parental leave for new mothers and fathers. - Fertility/Adoption assistance. - 2 weeks paid caregiver leave. - 401(k) plan matching up to 5%. - Tuition reimbursement. - Health & fitness benefits, discounts and resources. Compensation $99,440 - $124,300 Exempt Grade 17. Blue Cross and Blue Shield of Kansas offers excellent competitive compensation with the goal of retaining and growing talented team members. The compensation range for this role is a good faith estimate, it is estimated based on what a successful candidate might be paid. All offers presented to candidates are carefully reviewed to ensure fair, equitable pay by offering competitive wages that align with the individual's skills, education, experience, and training. The range may vary above or below the stated amounts. Our Commitment to Connection and Belonging At Blue Cross and Blue Shield of Kansas, we are committed to fostering a culture of connection and belonging, where mutual respect is at the foundation of our workplace. We provide equal employment opportunities to all individuals, regardless of race, color, religion, belief, sex, pregnancy (including childbirth, lactation, and related medical conditions), national origin, age, physical or mental disability, marital status, sexual orientation, gender identity, gender expression, genetic information (including characteristics and testing), military or veteran status, family or parental status, or any other characteristic protected by applicable law. Blue Cross and Blue Shield of Kansas conducts pre-employment drug screening, criminal conviction check, employment verifications and education as part of a conditional offer of employment.

Role Description The Strategic Sourcing Specialist will play a key role in driving the efficient acquisition of goods and services across the organization, focusing on delivering the best value solutions. This position involves overseeing the entire sourcing lifecycle, from understanding business needs to conducting RF(x) events, negotiating & drafting contracts, and managing the source-to-pay process. The specialist will participate in supplier selection activities, including competitive bids, establishing contracts, and handling contract administration and reporting. - Generate and implement efficient sourcing strategies through the RFx process. - Prepare and manage competitive bids (RFQ, RFP, etc.), including document preparation, proposal review, price analysis, negotiation of price and contract terms, scope review, and recommending selected bidders. - Develop and negotiate contracts with new suppliers and renegotiate existing contracts to achieve the best value solutions and savings objectives. - Maintain strategic sourcing relationships and foster the development of strong supplier partnerships. - Generate total value estimates and expenditure forecasts related to procurement. - Evaluate and streamline sourcing procedures, present improvement strategies to leadership, and implement solutions for continuous enhancement. - Drive the success of strategic sourcing goals and implement action items to ensure those objectives are met. - Develop strategies to improve the organization's cost structure. - Optimize external spending through early involvement in the sourcing lifecycle and collaboration with business stakeholders. - Demonstrate strong business judgment, integrity, financial acumen, and sourcing expertise. - Negotiate contracts and manage vendor relationships, focusing on key areas such as IT services, IT infrastructure, and indirect spend. - Evaluate supplier core competencies and competitive positioning, working with cross-functional stakeholders to reach agreements on contract terms and conditions. - Analyze industry trends and emerging technologies to proactively identify risks and opportunities, minimizing supply chain disruptions and ensuring continuity of supply. - Manage all aspects of purchase order administration, including submitting notices, change orders, new supplier onboarding, and closing out contracts. Qualifications - Bachelor’s degree in Supply Chain Management, Operations Management, Business, Mathematics, Statistics, or a related field, or a combination of relevant education and experience. - A minimum of 1 (one) year of experience in procurement, vendor management, and/or supply chain management, with direct involvement in strategic sourcing management. - Relevant certifications (e.g., Certified Professional in Supplier Diversity, Certified Professional in Supply Management) preferred. - Project management and process improvement experience preferred. - Previous IT procurement experience highly desired. - Experience identifying and implementing lean principles into workflows is a plus. Requirements - Skilled in conducting RFx events (RFPs, RFQs, RFIs), including preparation, supplier evaluation, and selection. - Able to manage multiple projects, prioritize tasks, and meet deadlines while maintaining attention to detail. - Proven ability to collaborate and influence stakeholders at all levels to drive successful outcomes. - Skilled in building and maintaining effective relationships with internal teams, suppliers, and vendors. - Proficient in researching, analyzing data, and presenting findings clearly for decision-making. - Quick to adapt to new technologies and tools, improving procurement efficiency. - Strong understanding of procurement policies, procedures, and supplier management to ensure compliance. - Capable of interpreting and negotiating contract terms, including redlining to protect the organization’s interests. - Experienced with sourcing and procurement tools, including contract lifecycle management systems. - Strong negotiation skills and ability to resolve conflicts for mutually beneficial outcomes. - Able to lead projects independently and in cross-functional teams to ensure success. - Excellent written and verbal communication for effective supplier and team engagement. - Ability to analyze data and use insights to make informed decisions that support organizational goals. Benefits - Base compensation is only one component of your competitive Total Rewards package. - Incentive pay program (EPIP). - Health/Vision/Dental insurance. - 6 weeks paid parental leave for new mothers and fathers. - Fertility/Adoption assistance. - 2 weeks paid caregiver leave. - 401(k) plan matching up to 5%. - Tuition reimbursement. - Health & fitness benefits, discounts and resources. Compensation $73,920 - $92,400 Exempt Grade 15 Blue Cross and Blue Shield of Kansas offers excellent competitive compensation with the goal of retaining and growing talented team members. The compensation range for this role is a good faith estimate, it is estimated based on what a successful candidate might be paid. All offers presented to candidates are carefully reviewed to ensure fair, equitable pay by offering competitive wages that align with the individual's skills, education, experience, and training. The range may vary above or below the stated amounts.

Role Description The Interoperability Engineer is a hands-on technical role responsible for driving technical design, development, and operational ownership of interoperability applications and services that enable real-time healthcare data exchange across internal systems, external partners, and regulatory APIs. This role builds production-grade applications, APIs, and event-driven services, while defining and implementing integration patterns and ensuring solutions are scalable, reliable, and compliant with CMS, ONC, and BCBSA interoperability mandates. Operating at the intersection of application development, integration engineering, platform ownership, and regulated production operations, this role is accountable for delivering and sustaining solutions from design through deployment, monitoring, and continuous improvement. Ownership is focused on the interoperability application layer and InterSystems HealthShare platform. This role influences technical direction within the interoperability domain and is accountable for ensuring solutions meet performance, reliability, and regulatory expectations. This position is eligible to work remotely, hybrid or onsite in accordance with our Telecommuting Policy. What you’ll do - Design, develop, and support interoperability applications, APIs, and event-driven services enabling real-time and near-real-time healthcare data exchange. - Build and maintain FHIR-based APIs aligned with CMS interoperability requirements and HL7 implementation guides (e.g., Patient Access, Payer-to-Payer, Provider Directory). - Drive technical design decisions and implement integration patterns across APIs, ingestion frameworks, and event-driven systems. - Design and deliver scalable solutions for complex, high-volume data exchange scenarios across internal and external systems. - Develop and optimize ingestion frameworks, data pipelines, and automation to support reliable and efficient data processing. - Lead root cause analysis and resolution of complex integration and data flow issues; define reprocessing strategies and system improvements. - Implement secure API access patterns, including OAuth2 and SMART on FHIR, ensuring proper authentication, authorization, and data protection. - Configure, extend, and optimize the InterSystems HealthShare platform, including development of custom services and integrations. - Ensure performance, reliability, scalability, and availability of interoperability services in production environments. - Collaborate with cross-functional teams and provide technical guidance to translate business and regulatory requirements into scalable solutions. Qualifications - Strong experience designing and building interoperability applications, APIs, and event-driven services in production environments. - Ability to drive or contribute to technical design decisions and implement scalable integration patterns across APIs, ingestion frameworks, and event-driven systems. - Proficiency in modern development languages (e.g., Java, .NET), SQL, and data validation techniques for building and optimizing data pipelines. - Experience developing and securing APIs using OAuth2, SMART on FHIR, or similar authentication and authorization frameworks. - Familiarity with healthcare interoperability standards (FHIR, HL7, CDA, X12, US Core, USCDI), implementation guides, terminology (SNOMED, LOINC, ICD-10, RxNorm), and validation tools (e.g., Inferno, Touchstone), or ability to quickly develop expertise. - Experience designing and supporting high-volume, enterprise-scale data exchange and ingestion processes. - Strong troubleshooting and root cause analysis skills across complex, distributed systems, including integration and data flow failures. - Experience working in production environments with responsibility for system reliability, monitoring, incident response, and performance optimization. - Familiarity with modern SDLC practices, version control (e.g., Git), Agile methodologies, and API testing tools (e.g., Postman or similar). - Experience with interoperability platforms such as InterSystems HealthShare, including development in ObjectScript (or similar technologies), is preferred. Requirements - High school or equivalent required. Bachelor’s degree in computer science, Information Systems, Health Informatics, or a related technical field, preferred. In lieu of degree, an additional 3 years relevant experience required. - Minimum 5 years of experience in software engineering, systems integration, or health IT environments. - Direct experience building or supporting FHIR-based systems in a payer or provider organization is strongly preferred. - Experience in regulated healthcare settings, especially those involving CMS or ONC oversight, is a plus. Physical Requirements - Office setting, with possible remote or hybrid work opportunities depending on the department. - Must be able to work at a computer for extended periods. - Participation in after-hours deployments or incident response may occasionally be necessary. Compensation $94,400 - $118,000 Exempt Grade IT&S 16 Blue Cross and Blue Shield of Kansas offers excellent competitive compensation with the goal of retaining and growing talented team members. The compensation range for this role is a good faith estimate, it is estimated based on what a successful candidate might be paid. All offers presented to candidates are carefully reviewed to ensure fair, equitable pay by offering competitive wages that align with the individual's skills, education, experience, and training. The range may vary above or below the stated amounts. Our Commitment to Connection and Belonging At Blue Cross and Blue Shield of Kansas, we are committed to fostering a culture of connection and belonging, where mutual respect is at the foundation of our workplace. We provide equal employment opportunities to all individuals, regardless of race, color, religion, belief, sex, pregnancy (including childbirth, lactation, and related medical conditions), national origin, age, physical or mental disability, marital status, sexual orientation, gender identity, gender expression, genetic information (including characteristics and testing), military or veteran status, family or parental status, or any other characteristic protected by applicable law. Blue Cross and Blue Shield of Kansas conducts pre-employment drug screening, criminal conviction check, employment verifications and education as part of a conditional offer of employment.