Director of Quality Assurance (QA)
BCBSNC - Durham, NC
Major Responsibilities: Lead the strategic direction for a comprehensive enterprise quality assurance program that delivers testing services throughout the system development lifecycle to ensure that applications are delivered to the business are free of defects and working per t...
BCBSNC - Durham, NC - Raleigh, NC
Blue Cross and Blue Shield of North Carolina is looking for an exceptional Director of Operations Support for our Durham and Winston Salem, NC call/contact centers. This key role will provide leadership, management, and strategy for management teams to ensure operational excellen...
Sr. Market Intelligence Analyst
BCBSNC - Durham, NC - Raleigh, NC
Provides company employees and management with strategic and tactical information and analysis of company business, markets, competitors and customers. Designs and manages research projects to aid decision-making and supports company goals. Responsible for interpreting and presen...
Director of Medicare Operations
BCBSNC - Durham, NC - Raleigh, NC
Responsible for managing the Claims, Billing, Enrollment and Reconciliation areas for the Medicare operational units. Works closely with the leadership team and operational areas to ensure the organization is meeting Medicare?s specific metrics and regulatory requirements. The po...
Program Manager - Corporate Pharmacy
BCBSNC - Chapel Hill, NC
Major Responsibilities: Manage, develop, and implement moderately complex programs. Provide program management including needs analysis, content development, data analysis, vendor management and contract management. Manage, develop, and implement moderately complex programs in ac...
BCBSNC - Durham, NC - Raleigh, NC
Responsible for the analysis, research and completion of complex, non-routine appeals and grievances within the company. Will address all customer concerns and ensure resolution and satisfaction. Ensure timeliness, quality and efficiency in all work to comply with mandated, legis...
Senior Strategic Contracting Consultant
BCBSNC - Durham, NC - Raleigh, NC
Responsible for leading the assessment, development, articulation, negotiation, implementation and management of enterprise and divisional innovative provider reimbursement initiatives, which are necessary to ensure BCBSNC holds a leading provider network capabilities position in...
BCBSNC - Durham, NC - Raleigh, NC
Leads and oversees design and development of new models of reimbursement for health systems, hospitals, independent physician organizations, as well as new organizations structured to facilitate payment coordination such as Accountable Care Organizations. Responsible for evaluati...
Business Intelligence (BI) Architect
BCBSNC - Chapel Hill, NC
Major Responsibilities: The BI Architect will collaborate with other domain architects, business representatives, & BI/DW professionals to define and implement an overall Business Intelligence strategy. This strategy will include the development of the ?presentation? layer (a...
BCBSNC - Chapel Hill, NC
Join BCBSNC?s Information Management team and be a part of the exciting work to expand our Information Management capabilities. We have a growing team of technical professionals focused on delivering our second generation data warehouse and a foundational Master Data Management s...
Medical Review Analyst (Certified Coder Preferred)
BCBSNC - Durham, NC - Raleigh, NC
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 Ana...