Job Description Develops and presents data-driven insights and program recommendations to large, self-funded employer groups and insurance brokers/consultants. Understands and communicates Blue Cross NC (BCNC) healthcare programs and services, medical policy, provider network/reimbursement strategies, cost drivers, and industry best practices. Defines and delivers tailored solutions to employer group customers through the analysis of relevant metrics to improve member health and positively impact quality and affordability of care. What You'll Do - Collaborates with internal stakeholders (i.e., Sales, Network, Data & Analytics, Quality) to develop and deliver tailored business presentations to positively impact employer group needs, improve BCNC competitive positioning, drive new membership, and improve retention. - Presents in annual/quarterly meetings with employer groups to review relevant data, assess programs, advise on various healthcare topics, and suggest solutions to meet employer goals and objectives. - Accesses diverse reporting sources and market intelligence to collect and analyze data, develop custom insights, and make recommendations. - Analyzes employer group financial, quality, and/or utilization data to determine success of current engagement approach and identifies further opportunities to lower healthcare cost, improve quality, and/or improve member health. - Supports responses to employer groups and presents information involving healthcare programs, operations, and policies to varied audiences. - Participates in relevant updates/calls/presentations with assigned employer groups and/or prospective clients. - Effectively cross sells opportunities and markets programs to best meet current or prospective client needs. - Assists with the planning and execution of key events for client groups (Healthcare Symposium, Advisory Councils). - Participates in cross-departmental workgroups and committees as needed. - Please note that travel within NC is required as a part of this position. What You'll Bring - Bachelor's degree or advanced degree - 3+ years of experience in related field - In lieu of degree, 5+ years of experience in related field Bonus Points - Experience working in healthcare and/or clinical experience/training. What You’ll Get - 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   Learn more   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. $81,068.00 - $129,708.00 Skills Collaboration, Data Driven Approach, Health Care, Healthcare Networks, Healthcare Operations, Internal Stakeholders, Medical Policy, Provider Services, Reimbursement Strategies, Stakeholder Management_____________________________________________________________________ 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.

• Assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members • Gather clinical information and apply the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation • Communicate with providers and other parties to facilitate care/treatment • Identify members for referral opportunities to integrate with other products, services and/or programs • Consult and lend expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function

• Maintain communication with SLPs on funding cases and instruct SLPs on document preparation and funding policies and regulations • Work with insurance providers, government agencies, and educational institutions to place new product, repair or rental orders • Track funding authorization cases ensuring requests are resolved to completion in a timely manner • Utilize on-line resources and maintain frequent communication with funding agencies to verify eligibility • Review prior authorization documents against third party payer criteria • Research previous orders and payment history/DSOs for any repair or new order requests • Enter and complete orders in the order management system database • Serve as a client advocate by communicating with clients and family members on funding requests and co-payment requirements, representing client’s case with third party insurance providers and troubleshooting any problems to resolution • Resolve third party denials and provide consultation to finalize difficult funding cases • Alert supervisor of potential third-party payer challenges • Perform various other duties as assigned

• Analyze complex business and technical requests and independently design, build, test, and deploy software solutions that support CMD’s evolving objectives. • Provide technical guidance, code reviews, and mentorship to elevate development practices within the team. • Ensure architecture consistency across platforms by collaborating closely with technology leadership and architecture teams. • Contribute to technical roadmaps and portfolio planning by identifying long‑term opportunities, risks, and modernization strategies. • Promote reuse and simplification by identifying opportunities to leverage existing solution components. • Ensure solutions are built using the appropriate technologies, comply with divisional standards, and meet functional and non‑functional requirements. • Define solution allocation across application areas, ensuring alignment with business rules embedded in core administration systems. • Perform deep‑dive analysis of production issues, respond promptly to outages, and partner with business stakeholders to troubleshoot and resolve system defects. • Identify optimization opportunities that enhance resilience, reduce manual effort, or improve system performance. • Conduct technical evaluations of software components, tools, and patterns to inform modernization initiatives. • Independently manage priorities, risks, dependencies, and issue resolution across concurrent initiatives. • Partner with various technology functions to ensure end‑to‑end solution quality and continuity of knowledge across the Life Admin ecosystem. • Contribute to a collaborative culture that encourages shared learning, broadens team capabilities, and strengthens cross‑functional alignment.