Blue Cross and Blue Shield of North Carolina - Durham, NC
Provides expert application knowledge that is global for a business area rather than being single process focused. The incumbent is sought when there is application considerations needed due to problems, projects, or for overall assessments. This role's oversight and strategic th...
Director of Quality Assurance (QA)
Blue Cross and Blue Shield of North Carolina - Durham, NC
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 the approved design, whil...
Blue Cross and Blue Shield of North Carolina - Chapel Hill, NC
Provides assistance and technical support for rating/pricing, valuation, and financial forecasting. Provides actuarial support to Network Management, Underwriting, and Sales and Marketing. - Supports the rating process by determining the need for and building actuarial model enha...
Blue Cross and Blue Shield of North Carolina - Durham, NC
Provide leadership, vision, and direction for the defined units within their business area. Lead and set goals for teams responsible for identifying, coordinating, and implementing initiatives/projects and activities that create efficiencies, optimize systems & processes, and pro...
Blue Cross and Blue Shield of North Carolina - Durham, NC
Handle all functions related to enterprise business support and/or project implementations including a mix of the following: quality assurance, development of process design, problem resolution, execution and development, training, coaching, mentoring, and providing leadership fo...
Blue Cross and Blue Shield of North Carolina - Durham, 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...
Blue Cross and Blue Shield of North Carolina - Chapel Hill, 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...
Blue Cross and Blue Shield of North Carolina - Durham, NC
Responsible for the analysis, development, installation, modification and support of complex software applications. May design software applications based on functional area assigned. - Independently analyze complex business problems or opportunities and prepare detailed specific...
Blue Cross and Blue Shield of North Carolina - Winston-Salem, NC
Responsible for the analysis, research and completion of standard appeals and grievances within the department. Will address all customer concerns and ensure resolution and satisfaction. Ensure timeliness, quality and efficiency in all work to comply with applicable mandated Stat...
Blue Cross and Blue Shield of North Carolina - Durham, NC
Handle all functions related to enterprise business support and/or project implementations including a mix of the following: quality assurance, development of process design, problem resolution, execution and development, training, coaching, mentoring, and providing leadership fo...
Fulfillment Release & Planning Manager
Blue Cross and Blue Shield of North Carolina - Durham, NC
Responsible for fulfillment business content and configuration delivery planning and scheduling for documents processed via Thunderhead and the Enterprise Fulfillment System. Collaborates closely with Fulfillment Services team members, document/content owners and coordinators to ...
Blue Cross and Blue Shield of North Carolina - Durham, 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...
Program Manager-Quality Based Networks
Blue Cross and Blue Shield of North Carolina - Chapel Hill, NC
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 accordance with guidelin...
Blue Cross and Blue Shield of North Carolina - Durham, NC
Provide leadership, vision, and direction for the BCBSNC call/contact centers. Lead and set goals for teams responsible for identifying, coordinating, and implementing initiatives/projects and activities that create efficiencies, optimize systems & processes, track workforce perf...
Manager, Analytics - Medical Expense Focus
Blue Cross and Blue Shield of North Carolina - Chapel Hill, NC
The primary focus of this role is to lead a coordinated enterprise analytic effort to identify drivers of medical expense trend and opportunities to impact that trend. Proven experience in medical expense analysis is key to success in this role. Manages the development, maintenan...
Blue Cross and Blue Shield of North Carolina - Chapel Hill, NC
Responsible for researching provider and subscriber allegations, complaints and inquiries where fraud, waste, abuse, or any other form of improper payment is suspected. Utilizes the fraud detection software to monitor and identify any provider payment outliers for improper billin...
Blue Cross and Blue Shield of North Carolina - Chapel Hill, NC
Based on established guidelines, the Intake Specialist processes a variety of internal and external member/provider requests and transactions related to services requiring prior plan approval, admission and pre-certification and discharge needs. Receives, screens, and enters data...
Blue Cross and Blue Shield of North Carolina - Chapel Hill, NC
Leverage technical knowledge of research and statistical methods, and/or deep understanding of health insurance business issues to find innovative and informative solutions to business problems. Work closely with staff across the enterprise to understand business processes, artic...
Senior Clinical Informatics Analyst
Blue Cross and Blue Shield of North Carolina - Chapel Hill, NC
Provide advanced consultative, analytical, and reporting support to customers on various projects; conducts complex ad hoc analysis as directed by management to include the evaluation of operational, clinical, disease management, quality and general business programs and processe...
Blue Cross and Blue Shield of North Carolina - Chapel Hill, NC
The Episodic Care Manager is responsible for performing medical reviews to assess, facilitate, and coordinate the delivery of care across the Health Care System. The Episodic Care Manager acts as a member advocate to promote and coordinate the delivery of quality, cost effective ...