Identifies, analyzes, and determines medical necessity, pre existing conditions, benefit eligibility and/or individual consideration reimbursement allowances for novel and complex medical management related claims, using varied and broad clinical expertise. The Medical Review Analyst acts as a member advocate to promote and coordinate the delivery of quality, cost effecti

Dependent on clinical discipline, the Case Manager / Health Coach coordinates appropriate care, resources and/or services of selected member populations. Provides guidance and promotes effective utilization and monitoring of health care resources to drive quality care for our members. Collaborates as needed with varied members of the healthcare team to achieve optimal cli

Leads and manages the day to day operational and tactical aspects of all Medicare related PBM (Pharmacy Benefit Manager) activities, new initiatives, and other ongoing business deliverables in accordance with business needs. Identifies, evaluates, and resolves issues that conflict with PBM related deliverables. Collaborates closely with project team members, business owne

The Certero Sr. Asset Management Analyst will be responsible for overseeing the life cycle planning of corporate assets through asset selection, operation, refresh, migration, optimization, retirement and disposal; including building, technology, software, furniture, fixtures and/or equipment assets. Independently perform the analysis, design and development of high volum

IT is different here. Our work as technology specialists pushes the boundaries of what's possible in health care. You will build solutions that make a real difference in people's lives. Driven by the importance of their work, our team members innovate to elevate. We're encouraged to be curious, collaborate, and turn ideas into solutions that can make health care better fo

The Compliance Advisor is responsible for performing day to day activities required to maintain an effective compliance program, including the coordination of complex, cross functional matters related to organizational compliance. Identifies compliance risks, develops and/or facilitates implementation of corrective action plans and conducts audits/compliance reviews to mo

The Quality and Risk Adjustment Engagement Specialist provides cross functional and cross team support for operational and/or healthcare functions supporting members in the Medicare Advantage and ACA populations and other LOBs as assigned, to ensure Quality and Risk Adjustment care gaps are addressed and closed by guiding the member to a PCP, advising of available benefit

SQL programming (Advance SQL programming) Demonstrated experience with design and implementation of analytic models and methodologies for new applications Proficiency in Python Advanced experience working with large and complex data sets to develop regression and classification models. Deep knowledge of state of the art techniques in machine learning, statistics, optimiza

IT is different here. Our work as technology specialists pushes the boundaries of what's possible in health care. You will build solutions that make a real difference in people's lives. Driven by the importance of their work, our team members innovate to elevate. We're encouraged to be curious, collaborate, and turn ideas into solutions that can make health care better fo

IT is different here. Our work as technology specialists pushes the boundaries of what's possible in health care. You will build solutions that make a real difference in people's lives. Driven by the importance of their work, our team members innovate to elevate. We're encouraged to be curious, collaborate, and turn ideas into solutions that can make health care better fo

At Blue Cross and Blue Shield of NC, we are accelerating the future of healthcare and doing it together, asking bold questions and taking on tough challenges through deep, sincere, and honest collaboration. In this role you will be part of the digital transformation at Blue Cross Blue Shield of NC, and you will be responsible for transformation of custom applications into

The Blue Cross NC Diversified Business Group (DBG) is focused on driving improvements in health care, affordability, access and equity through investments and partnerships with innovative health care organizations in North Carolina and beyond. We have a history of forging forward thinking partnerships and investments with like minded partners to create the blueprint of th

The Sr. Insights Analyst will be responsible for providing advanced analytic support, which includes data collection, trending, analytics, reporting and forecasting functions to ensure data integrity. The Senior Insights Analyst will prepare complex data for various internal and external customers. Conduct complex day to day ad hoc analytics, and work with analytics opera

We are the model of what's possible in healthcare. The Blue Cross NC Diversified Business Group (DBG) is focused on driving improvements in health care, affordability, access and equity through investments and partnerships with innovative health care organizations in North Carolina and beyond. We have a history of forging forward thinking partnerships and investments with

Lead medium scale, enterprise wide Product Development initiatives aimed at keeping the current product offering for a specific market segment current and competitive. Acts as the primary liaison between segment sales, segment strategy, and the different delivery teams ensuring that their respective refresh/scope optimally delivers on the desired business outcomes. Act as