Blue Cross and Blue Shield of North Carolina

Role Description As a senior member of the strategic function, provide detailed assessment and understanding of the current and future external market environment, develop insights and identify opportunities to actualize our organizational mission, vision and activate the strategy across multiple time horizons. Support a focus on insight-driven decisions, innovation, customer centric experience and local/national collaborations. Work collaboratively to build coalition and support as well as drive action with both internal and external partners. Develop and refine strategic plans and initiatives to positively impact the management of today’s business while supporting efforts for the definition and evolution towards a health solutions company. What You'll Do - Work directly with staff and senior leadership across the company to proactively identify and prioritize strategic needs and create meaningful and actionable outputs. - Drive the strategic development process to address these needs and integrate and align work to the company’s overall strategic goals. - Build and facilitate efforts with partner and/or vendor relationships to understand the value proposition and business case aligned to our business strategy. - Drive decision making and collaborate with the business areas to implement. - Develop and maintain relationships with both internal and external partners to drive complex project/initiative work focused on significant business strategies, opportunities and innovation efforts. - Leverage customer and consumer insights to develop holistic strategies, programs and plans to effectively drive innovation and business outcomes and maximize ROI in varied areas. - Contribute to the development Health Plan Strategy positions and related annual and long-term planning efforts. - Design and develop the innovation program for Blue Cross NC – its offerings, innovation events, delivery methods, and definition of the success points of the program. - Act as a “Champion of Innovation” and work across the organization to drive a culture of innovation in all that we do. - Partner and consult with internal clients to identify, plan and execute innovation efforts; help them better understand what problems they are trying to solve, articulate their vision and define and enable success. - Provide methods and resources to support their execution of those plans. - Identify, analyze and monitor relevant industry, regulatory, technology and market based trends to determine market entry or exit as appropriate and to ensure alignment to the company’s strategic positions and interests. - Partner with Commercial, Government, and Shared Services to align roadmaps and health plan strategy. - Build and validate business cases aligned to financial targets and long-term growth objectives. Qualifications - Bachelor's degree or advanced degree (where required). - 5+ years of experience in related field. - In lieu of degree, 7+ years of experience in related field. Bonus Points - Demonstrates expertise in developing comprehensive business cases. - Proven experience presenting complex concepts and recommendations to senior leadership. - Strong understanding of health plan strategy. Benefits - The opportunity to work at the cutting edge of health care delivery with a team that’s deeply invested in the community. - Work-life balance, flexibility, and the autonomy to do great work. - Medical, dental, and vision coverage along with numerous health and wellness programs. - Parental leave and support plus adoption and surrogacy assistance. - Career development programs and tuition reimbursement for continued education. - 401k match including an annual company contribution. Salary Range At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs. Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs. *Based on annual corporate goal achievement and individual performance. $107,901.00 - $172,642.00 Job Alert Fraud We have become aware of scams from individuals, organizations, and internet sites claiming to represent Blue Cross and Blue Shield of North Carolina in recruitment activities in return for disclosing financial information. Our hiring process does not include text-based conversations or interviews and never requires payment or fees from job applicants. All our career opportunities are published on https://bcbsnc.wd5.myworkdayjobs.com/en-US/BCBSNC . If you have already provided your personal information that you suspect is fraudulent activity, please report it to your local authorities. Any fraudulent activity should be reported to: HR.Staffing@BCBSNC.com .

Role Description The Claims Operations Expert is a subject matter expert that enables accelerated claims resolution and production support to manage inventory. Responsibilities include: - Resolve escalated claims from less experienced team members following the formal escalation protocol. - Manage work production schedule to balance provider segment preference and staff availability. - Identify and resolve errors on custom or special project claims. What You'll Do: - Serve as a subject matter expert for employees’ inquiries around work process, procedures, products, policies, etc. - Process a variety of customer transactions that may include non-routine suspended claims, inquiries, adjustments, and correspondence for any business segment. - Contribute in sessions to discuss claims processing workflow and make improvement suggestions to speed up overall claims quality and lead time. - Identify problems, gaps or inconsistencies in workflows and processes; recommend updates, alternatives and/or solutions. - Assist training team in development of claims production staff to be customer centric, cross functional, data driven personnel. - Support Provider Services in resolving immediate issues directly impacting provider financial well-being. - Review claims for possible “fraud” and identify root cause by conducting forensic analysis to the problem. - Serve as subject matter expert for project, testing, and validation of claims work processes and procedures. - Communicate with Customer Service and Provider Services to understand key focus of service segment. - Act as a point of contact for NCQA and NCDOI for compliance. - Act as a point of contact for internal and/or external audits and projects as necessary; assist in planning, scoping, testing, training and implementation. - Identify and document escalated, recurring or complex system and process problems. - Interface with project teams to resolve these complex issues. Qualifications - High school diploma or GED. - 5+ years of experience in related field. Requirements - Claims Analysis - Claims Management - Claims Operations - Claims Processing - Claims Resolution - Claims Support - Health Insurance Portability & Accountability Act (HIPAA) - Insurance - Insurance Claim Handling - Insurance Claims Investigations - Insurance Procedures - Medical Claims - People Management - Workflow Management Benefits - Annual Incentive Bonus* based on annual corporate goal achievement and individual performance. - 401(k) with employer match. - Paid Time Off (PTO). - Competitive health benefits and wellness programs. Salary Range $45,761.00 - $73,217.00 Job Alert Fraud We have become aware of scams from individuals, organizations, and internet sites claiming to represent Blue Cross and Blue Shield of North Carolina in recruitment activities in return for disclosing financial information. Our hiring process does not include text-based conversations or interviews and never requires payment or fees from job applicants. All our career opportunities are published on https://bcbsnc.wd5.myworkdayjobs.com/en-US/BCBSNC . If you have already provided your personal information that you suspect is fraudulent activity, please report it to your local authorities. Any fraudulent activity should be reported to: HR.Staffing@BCBSNC.com .

Role Description Engage Medicare members, pharmacies, and providers to close adherence and SUPD (Statin Use in Persons with Diabetes) gaps. - Complete Comprehensive Medication Reviews (CMRs) with Medicare members. - Make outreach to Medicare members to assist in removing barriers to medication adherence. - Partner with pharmacies and providers to close adherence gaps when the Medicare member is unengaged or when the Medicare member requires assistance. - Contact providers to close SUPD (Statin Use in Persons with Diabetes) gaps. - Complete Comprehensive Medication Reviews (CMRs) with eligible Medicare members to give the member a better understanding of their medications and health. - Send interventions to providers through fax or the CMR platform to alert the provider of potential drug interactions and adverse reactions, dose changes, adherence issues, etc. - Provide counseling to Medicare members regarding medications. - Provide Medicare members with information regarding their pharmacy benefits (i.e., formulary, preferred pharmacy, supplemental benefits, etc.). - Provide clinical guidance and support to the Pharmacy Quality Specialists. Qualifications - Bachelor's degree or advanced degree. - 3+ years of experience in related field. - Current state pharmacy license. Requirements - Salary Range: $118,691.00 - $189,906.00. - Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications, and other business and organizational needs. - Base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs. - *Based on annual corporate goal achievement and individual performance. Benefits - Annual Incentive Bonus* - 401(k) with employer match - Paid Time Off (PTO) - Competitive health benefits and wellness programs Company Description We have become aware of scams from individuals, organizations, and internet sites claiming to represent Blue Cross and Blue Shield of North Carolina in recruitment activities in return for disclosing financial information. Our hiring process does not include text-based conversations or interviews and never requires payment or fees from job applicants. All our career opportunities are published on https://bcbsnc.wd5.myworkdayjobs.com/en-US/BCBSNC . If you have already provided your personal information that you suspect is fraudulent activity, please report it to your local authorities. Any fraudulent activity should be reported to: HR.Staffing@BCBSNC.com .

Role Description The Director, Enterprise Architecture & Technology Strategy will oversee architecture as a centralized, strategic function, ensuring that technology selection, integration, and innovation are approached holistically across the enterprise. This version emphasizes high-level strategic influence and governance, making it ideal for situations where enterprise technology decisions must align closely with business growth and innovation goals. The role serves as a trusted advisor to executive leadership, promoting architectural best practices and emerging technologies to enhance competitive advantage. What You’ll Do - Technology Strategy & Execution: Define and deliver enterprise technology and architecture strategies that enable business growth, innovation, and healthcare digital transformation. Ensure technology roadmaps are aligned with corporate strategy and product priorities. - Enterprise Architecture Governance: Establish and enforce architecture standards, principles, and reference architectures to ensure consistency, security, and scalability. Support the Architecture Review Board and ensure major initiatives comply with enterprise architecture guidelines. - Technology Decision Leadership: Provide strategic guidance on key technology decisions, from solution architecture to enterprise platforms. Evaluate emerging technologies, frameworks, and vendors, balancing innovation with risk, cost, and long-term sustainability. - Integration & Modernization: Lead enterprise integration and modernization efforts, including APIs, data interoperability, clinical data exchange, and cloud transformation. Reduce technical debt and modernize legacy platforms to improve agility and speed to market. - Thought Leadership & Innovation: Monitor industry trends and emerging technologies to drive innovation and business value. Represent the organization’s technology vision with external partners and industry peers. - Cross-Functional Collaboration: Partner with business and IT leaders to align architecture with strategic objectives. Communicate complex technical concepts clearly to both technical and non-technical stakeholders and facilitate early architectural alignment on major initiatives. - Risk, Security & Compliance: Embed security, compliance, and risk management into all architecture decisions. Collaborate with Information Security and Risk teams to ensure alignment with regulatory and cybersecurity standards. - Financial Stewardship: Guide cost-effective architectural decisions that maximize platform reuse and optimize total cost of ownership. Provide architectural input into IT investment and budget planning. - Solution Design & Delivery Support: Provide oversight and guidance to solution architects to ensure scalable, secure, and resilient designs. Engage early in the delivery lifecycle to address complex design challenges and ensure alignment with standards. - People Leadership & Development: Lead and develop a high-performing architecture team through clear goals, mentorship, and continuous learning. Build leadership capability and succession within the architecture function. - Metrics & Value Realization: Define and track architecture KPIs to measure impact and value. Communicate outcomes in terms of business value, risk reduction, and cost efficiency to demonstrate return on investment. Qualifications - Bachelor’s degree in Computer Science, Information Systems, or a related field. - 15+ years of progressive IT experience, including at least 5 years in technology leadership roles (Director or above). - A master’s degree is preferred but not required. - Demonstrated success leading technology strategy and enterprise architecture in complex environments, within healthcare. - Experience with healthcare standards such as X12/FHIR/HL7. - Hands-on experience with modern technology stacks and architectural frameworks, including cloud platforms, microservices, APIs, event-driven systems, data analytics, AI/ML, observability/service management, and Dev/Sec/Data/AI/Ops practices. - Proven experience with large-scale enterprise platforms—such as Facets, Salesforce, and Snowflake—as well as public cloud ecosystems like AWS, Azure, and GCP. - Strong strategic planning and analytical skills, with a track record of developing multi-year technology roadmaps aligned to business objectives. - Exceptional leadership and communication skills, with the ability to mentor technical teams and influence executive and senior stakeholders. - Extensive experience overseeing end-to-end solution delivery, proactively managing architectural risk, and addressing complex technical and organizational challenges. - Build and lead a high-performing architecture team through effective coaching, mentorship, and clear accountability. Bonus Points - Background in technology consulting or advisory services (e.g., leading technology strategy engagements, enterprise architecture consulting, technology management consulting) is highly valued. - Master’s degree in Computer Science, Information Systems, Business Administration, or a related field preferred. - Experience in mergers and acquisitions (M&A) from a technology integration perspective is a plus. - Familiarity with business architecture, Technology Business Management (TBM), or enterprise operating model design. Benefits - The opportunity to work at the cutting edge of health care delivery with a team that’s deeply invested in the community. - Work-life balance, flexibility, and the autonomy to do great work. - Medical, dental, and vision coverage along with numerous health and wellness programs. - Parental leave and support plus adoption and surrogacy assistance. - Career development programs and tuition reimbursement for continued education. - 401k match including an annual company contribution. Salary Range At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs. Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs. *Based on annual corporate goal achievement and individual performance. $191,153.00 - $305,845.00 Job Alert Fraud We have become aware of scams from individuals, organizations, and internet sites claiming to represent Blue Cross and Blue Shield of North Carolina in recruitment activities in return for disclosing financial information. Our hiring process does not include text-based conversations or interviews and never requires payment or fees from job applicants. All our career opportunities are published on our careers page . If you have already provided your personal information that you suspect is fraudulent activity, please report it to your local authorities. Any fraudulent activity should be reported to: HR.Staffing@BCBSNC.com.

Role Description CDX CSA: Responsible for the elicitation, prioritization, and conversion of business/functional requirements to system requirements, as well as provision of analysis for applications in production (large and/or more complex initiatives). Responsible for the development of functional designs for new, customized, or enhanced systems. The ultimate outcome of this role is the production of clear, timely, precise and accurate technical designs that are traceable to documented business/functional requirements and guide the successful design, development and deployment of IT Solutions. Coordinate Analysis and Functional Design: - Quickly understand larger and/or more complex business issues and data challenges of the customer. - Critically evaluate information gathered from multiple sources, reconcile conflicts, and decompose high-level information into details; abstract up from low-level information to a general understanding. - Utilize expertise in analyzing end to end business and technical flows, including impacts to operations. - Review, edit, and prioritize business requirements, specifications, processes and recommendations related to proposed solution. - Distinguish user requests from the underlying true business need. - Translate business/functional requirements into system level functional solutions using various techniques that include: - Interviews - Document analysis - Requirements workshops - Surveys - Site visits - Business process descriptions - Use cases - Screen interface prototypes - Demos - Business, task, and workflow analysis - Coordinate the development of functional design specifications, GUI and screen interface designs (internal applications), and VUI designs for customer engagements. - Include project assumptions, risks/issues, considerations, and dependencies based on the system impacts. - Proactively identify the business process and organizational impact of proposed solutions. Coordinate Technical Recommendations and Traceability - Guide project personnel to identify required system changes, additions or retirement. - Conduct gap analysis for business/functional requirements and current system functionality, with support, review and input from other Technical staff. - Collaborate with business analysts, designers, developers and subject matter experts to establish the technical vision and analyze tradeoffs between usability and performance needs. - Provide expertise for dividing the project into multiple phases based on the business priorities, design, schedule, and level of effort. - Ensure traceability from business/functional requirements through development of the solution, to confirm system functionality and ensure the completed system fulfills the goals of the project as detailed in the specifications. - Mentor less experienced staff and coordinates work as needed for larger projects. Qualifications - Bachelor's degree or advanced degree (where required) - 5+ years of experience in related field. - In lieu of degree, 7+ years of experience in related field. Requirements - Application Development - Business Requirements Analysis - Design - Mentoring Staff - Requirements Analysis - Requirements Gathering - Solutions Development - Systems Analysis - Systems Engineering - Technical Designs Benefits - Annual Incentive Bonus* - 401(k) with employer match - Paid Time Off (PTO) - Competitive health benefits and wellness programs Salary Range $98,092.00 - $156,947.00 *Based on annual corporate goal achievement and individual performance. Job Alert Fraud We have become aware of scams from individuals, organizations, and internet sites claiming to represent Blue Cross and Blue Shield of North Carolina in recruitment activities in return for disclosing financial information. Our hiring process does not include text-based conversations or interviews and never requires payment or fees from job applicants. All our career opportunities are published on https://bcbsnc.wd5.myworkdayjobs.com/en-US/BCBSNC . If you have already provided your personal information that you suspect is fraudulent activity, please report it to your local authorities. Any fraudulent activity should be reported to: HR.Staffing@BCBSNC.com .

Role Description The Head of Performance Marketing will lead digital marketing across all digital channels, including search engines, social, and display, and they will lead marketing analytics for the division. The ideal candidate will demonstrate superior technical expertise and organizational capabilities in project and campaign management, analytics, communications evaluation, data modeling, relationship skills, and commercial awareness. - Set the vision and lead a team of 8-10 people managing the audience development and engagement strategies for all digital marketing channels. - Craft and implement a clear, cohesive digital media channel strategy that supports Blue Cross NC’s brand strategy, member acquisition, and retention goals. - Articulate how the channel strategy drives engagement with key audiences, including: - Developing and maintaining audience segment definitions/personas. - Using audience research and digital paid media channel metrics to identify audience insights that will inform the division and team’s work. - Develop full-funnel acquisition digital marketing campaigns, establishing evergreen campaigns while consistently testing new audiences, CTAs, creative, channels, and formats. - Develop measurement framework with clear critical metrics and targets to measure ongoing channel health and performance as well as frameworks for evaluating key campaigns and moments across channels. - Analyze program performance as well as industry trends to develop plans and implement for the optimal marketing mix and translate campaign metrics into meaningful insights. - Develop and provide analytics to report on program results, both at the top-line and campaign levels, ensuring optimal ROI/ROAS against marketing budget and overall ecommerce revenue goals. - Manage and aggregate channel level reporting to help build an integrated view of our acquisition landscape and advertising effectiveness through multiple lenses of attribution. - Develop and execute retention and customer lifecycle strategies that maximize customer engagement, loyalty, and lifetime value. - Measure and analyze retention and customer lifecycle metrics to identify opportunities for improvement and track the success of retention and customer lifecycle programs. - Continually optimize retention and customer lifecycle programs and initiatives through ongoing testing, analysis, and iteration. - Implement and manage comprehensive test and learn strategy. Qualifications - Bachelor's degree or advanced degree (where required). - 10+ years of experience in related field. - In lieu of degree, 12+ years of experience in related field. Requirements - Detail-oriented, self-starter, curious and innovative mindset, with the ability to react quickly to changing priorities without full guidance. - Data-driven, analytical, and solution-oriented. - Thrives in a fast-paced environment and is good at dealing with ambiguity. - Expert level knowledge working with various digital technology vendors, platforms, and solutions, including Salesforce and SAS, Google Analytics, SQL, Power BI, or similar tools. Benefits - Annual Incentive Bonus* based on annual corporate goal achievement and individual performance. - 401(k) with employer match. - Paid Time Off (PTO). - Competitive health benefits and wellness programs. Salary Range $157,978.00 - $252,765.00 Job Alert Fraud We have become aware of scams from individuals, organizations, and internet sites claiming to represent Blue Cross and Blue Shield of North Carolina in recruitment activities in return for disclosing financial information. Our hiring process does not include text-based conversations or interviews and never requires payment or fees from job applicants. All our career opportunities are published on our careers page . If you have already provided your personal information that you suspect is fraudulent activity, please report it to your local authorities. Any fraudulent activity should be reported to: HR.Staffing@BCBSNC.com .

Role Description Lead and coordinate work efforts to provide detailed assessment and understanding of the current and future external market environment, develop insights and identify opportunities to actualize our organizational mission, vision and activate the strategy across multiple time horizons. - Champion insight-driven decisions, innovation, customer centric experience and local/national collaborations. - Work collaboratively to build coalition and support as well as drive action with both internal and external partners. - Lead the development and refinement of strategic plans and complex, highly visible initiatives to positively impact the management of today’s business. - Be accountable for the more complex planning involved in longer term strategies focused on the definition and evolution towards a health solutions company. - Work directly with staff and senior leadership across the company to proactively identify and prioritize strategic needs. - Create meaningful and actionable outputs, drive the strategic development process to address these needs, and integrate and align work to the company’s overall strategic goals. - Lead efforts with partner and/or vendor relationships to understand the value proposition and business case aligned to our business strategy. - Drive decision making and collaborate with the business areas to implement. - Develop and manage relationships with both internal and external partners to drive highly complex project/initiative work. - Leverage customer and consumer insights to develop holistic strategies, programs and plans to effectively drive business outcomes and maximize ROI. - Oversee the consolidation of research, authorship of key findings, and communication of timely, periodic strategic intelligence reports to senior management and Blue Cross NC Board. - Lead development of corporate strategic positions and related annual and long-term planning development efforts. - Collaborate and execute critical and highly complex activities such as strategic planning, compliance, and highly complex financial/qualitative analysis. - Lead efforts to design, develop, and execute the innovation program for Blue Cross NC. - Act as a “Champion of Innovation” and work across the organization to drive a culture of innovation. - Provide methods and resources to support the execution of those plans. - Lead the development of new ideas that solve existing or emerging issues the business faces. - Prototype and evaluate those ideas to determine viability and opportunity for success and follow through to implementation as necessary. - Oversee efforts to identify, analyze and monitor relevant industry, regulatory, technology and market based trends. Qualifications - Bachelor's degree or advanced degree (where required). - 8+ years of experience in related field. - In lieu of degree, 10+ years of experience in related field. Requirements - Salary Range: $130,560.00 - $208,896.00. - Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications, and other business and organizational needs. - Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs. - *Based on annual corporate goal achievement and individual performance. Benefits - Annual Incentive Bonus* - 401(k) with employer match - Paid Time Off (PTO) - Competitive health benefits and wellness programs Company Description We have become aware of scams from individuals, organizations, and internet sites claiming to represent Blue Cross and Blue Shield of North Carolina in recruitment activities in return for disclosing financial information. Our hiring process does not include text-based conversations or interviews and never requires payment or fees from job applicants. - All our career opportunities are published on https://bcbsnc.wd5.myworkdayjobs.com/en-US/BCBSNC . - If you have already provided your personal information that you suspect is fraudulent activity, please report it to your local authorities. - Any fraudulent activity should be reported to: HR.Staffing@BCBSNC.com .

Role Description Participates in the planning, designing, and implementation of technical infrastructure to support business objectives. In addition, will support activities related to documenting technical costs, technical options/feasibility, technical risks, etc. Will serve as an expert in at least one technology area. Responsible for working under general direction on assignments within their unit. What You'll Do - Support Software Development - Assess technical needs and translate them into technical plans - Provide technical support for projects - Plan, design, and implement technical infrastructure to support business objectives - Perform system integration activities for projects (technical integration testing, inoperability assessments, etc.) - Deliver timely, cost-effective application/technical solutions for projects - Develop Business Opportunities - Apply broad understanding of hardware and software to business problems - Determine timeframe for deliverables - Support Business Analyst activities related to documenting costs, options, feasibility, risks, etc. - Ensure proposed technical solutions fit with infrastructure and architecture standards - Support System Stability - Ensure problem resolution and project integration - Provide expert back-up for the various systems/applications/technologies for applicable area of responsibility Qualifications - Bachelor's degree or advanced degree (where required) - 3+ years of experience in related field - In lieu of degree, 5+ years of experience in related field Requirements - 1-2 years of exposure to Workday, preferred (HCM, Recruiting, Learning, Compensation, Benefits, etc.) - Familiarity with reporting/data within Workday Benefits - The opportunity to work at the cutting edge of health care delivery with a team that’s deeply invested in the community - Work-life balance, flexibility, and the autonomy to do great work - Medical, dental, and vision coverage along with numerous health and wellness programs - Parental leave and support plus adoption and surrogacy assistance - Career development programs and tuition reimbursement for continued education - 401k match including an annual company contribution Salary Range At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs. Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs. *Based on annual corporate goal achievement and individual performance. $89,174.00 - $142,679.00 Job Alert Fraud We have become aware of scams from individuals, organizations, and internet sites claiming to represent Blue Cross and Blue Shield of North Carolina in recruitment activities in return for disclosing financial information. Our hiring process does not include text-based conversations or interviews and never requires payment or fees from job applicants. All our career opportunities are published on https://bcbsnc.wd5.myworkdayjobs.com/en-US/BCBSNC . If you have already provided your personal information that you suspect is fraudulent activity, please report it to your local authorities. Any fraudulent activity should be reported to: HR.Staffing@BCBSNC.com .

Role Description We are seeking an early-career Actuarial Associate who is eager to apply their knowledge of mathematics, probability, statistics, and business principles in a supportive, team-based environment. Under direct guidance and supervision, this role provides hands-on technical support for rating and pricing, valuation, healthcare economics, and financial forecasting. The Actuarial Associate will work alongside experienced actuaries and collaborate with teams across Network Management, Underwriting, Sales and Marketing, Finance, and Healthcare while building a strong foundation for a career in actuarial science. What You’ll Do - Analyzes financial, statistical and mathematical data and performs actuarial calculations. - May assist in the determination of pricing, reserves and/or cash flow projections. - Assists in performing rate studies used in determining rate adequacy. - Assists in actuarial research, experience studies, and statistical analyses and calculations. - Provides support to senior analysts or actuaries as required. - Retrieves and validates data for rate filings and actuarial models. - Assists senior staff in the building of model enhancements and determines reasons for changes to calculated factors. - Distributes established reports and responds to inquiries. - Investigates trends and anomalies. - Supports Enterprise Risk Management. - Provides analytic support for corporate and departmental projects. - Is a participant in good standing in the Actuarial Development Program. Qualifications - Bachelor's degree or advanced degree (where required). - 0-2 years of experience in related field. - Enrolled in the actuarial student program and is committed to completing the Society of Actuaries education system courses necessary to attain the ASA designation. Benefits - The opportunity to work at the cutting edge of health care delivery with a team that’s deeply invested in the community. - Work-life balance, flexibility, and the autonomy to do great work. - Medical, dental, and vision coverage along with numerous health and wellness programs. - Parental leave and support plus adoption and surrogacy assistance. - Career development programs and tuition reimbursement for continued education. - 401k match including an annual company contribution. Salary Range At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs. Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs. *Based on annual corporate goal achievement and individual performance. $66,998.00 - $107,197.00 Job Alert Fraud We have become aware of scams from individuals, organizations, and internet sites claiming to represent Blue Cross and Blue Shield of North Carolina in recruitment activities in return for disclosing financial information. Our hiring process does not include text-based conversations or interviews and never requires payment or fees from job applicants. All our career opportunities are published on https://bcbsnc.wd5.myworkdayjobs.com/en-US/BCBSNC . If you have already provided your personal information that you suspect is fraudulent activity, please report it to your local authorities. Any fraudulent activity should be reported to: HR.Staffing@BCBSNC.com .

Role Description We are seeking an Appeals Analyst to research, analyze, and process appeals, coding disputes, and grievances. In this role, you will ensure work is completed timely, accurately documented, and aligned with legislative and regulatory requirements, quality standards, and organizational policies and procedures. You will also help resolve customer concerns with a focus on timely outcomes and customer satisfaction. - Analyze, research, resolve and respond to confidential/sensitive appeals, coding disputes, grievances and coverage/organization determinations from members, member's representatives, providers, media outlets, senior leadership and regulatory agencies with established regulatory and accreditation guidelines. - Analyze, interpret, and explain health plan benefits, policies, procedures, medical terminology, coding and functions to members and/or providers. - Regularly and independently exercise judgement to make appropriate decisions based on BlueCross NC policies and guidelines. Acts decisively to ensure business continuity and with awareness of all possible implications and impact. - Prepare files and develop BlueCross NC position statements for external reviews performed by independent review organizations, benefit panels and external medical consultants. - Provide comprehensive appeals, coding disputes and grievances responses that support the decision and comply with regulatory and accreditation guidelines. - Document extensive investigation, relative findings, and actions in all applicable systems. - Accountable for monitoring daily reports to ensure service timeliness and compliance is met. - Gather clinical information by using established criteria provided in corporate medical policies; partner with Medical Directors who are responsible for all decisions regarding clinical appeals/grievances. - Ensure timeliness, quality, and efficiency in all work to comply with applicable mandated State (NCDOI) and/or Federal (Centers for Medicare & Medicaid Services (CMS), ERISA, etc.) accreditation agency standards (National Committee for Quality Assurance – NCQA), ASO group performance guarantees and BCBSNC policies and procedures (to include BCBSA requirements). Qualifications - Bachelor’s degree or advanced degree where required. - 3 years of related experience. - In lieu of degree, 5 years of related experience. - For coding disputes area, certified professional coder must be obtained within 1 year of employment. Requirements - Certified Professional Coder through AAPC – Highly preferred. - Healthcare Claims adjudication appeals or reimbursement experience – Highly preferred. - Experience with Payor or Provider appeals – Highly Preferred. - Knowledge of Medicare and/or Commercial CMS guidelines - Highly Preferred. - Strong analytical and critical thinking abilities. - Excellent organizational skills. - Ability to prioritize competing deadlines. - Experience working in fast-paced environment. - Proficiency in Microsoft Office and Excel. Benefits - The opportunity to work at the cutting edge of health care delivery with a team that’s deeply invested in the community. - Work-life balance, flexibility, and the autonomy to do great work. - Medical, dental, and vision coverage along with numerous health and wellness programs. - Parental leave and support plus adoption and surrogacy assistance. - Career development programs and tuition reimbursement for continued education. - 401k match including an annual company contribution. Salary Range At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs. Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs. *Based on annual corporate goal achievement and individual performance. $50,337.00 - $80,539.00 Skills - Confidentiality - Government Regulation - Law - Medicaid - Medicare - Policies & Procedures - Policy Development - Policy Procedures - Regulatory Compliance - Standards Compliance Job Alert Fraud We have become aware of scams from individuals, organizations, and internet sites claiming to represent Blue Cross and Blue Shield of North Carolina in recruitment activities in return for disclosing financial information. Our hiring process does not include text-based conversations or interviews and never requires payment or fees from job applicants. All our career opportunities are published on https://bcbsnc.wd5.myworkdayjobs.com/en-US/BCBSNC . If you have already provided your personal information that you suspect is fraudulent activity, please report it to your local authorities. Any fraudulent activity should be reported to: HR.Staffing@BCBSNC.com .