Jobs at Blue Cross Blue Shield Association

Provide expert functional support and business analysis for PeopleSoft Financials: troubleshoot production issues, gather requirements, design solutions, lead implementations/upgrades, manage testing and projects, develop training and documentation, and drive process and system enhancements to improve efficiency and reporting.

Lead HEDIS data quality strategy and operations, oversee portal and QCR profiling, perform advanced data analyses, coordinate cross-functional partners, ensure NCQA-compliant reporting, and drive continuous improvement in HEDIS processes.

Lead and perform complex financial audits and reviews, evaluate compliance with federal and contractual requirements, develop corrective action plans, train staff, serve as subject matter expert for audit policies, recommend billing rates, and manage contract administration activities with stakeholders.

Lead Accreditation and Quality operations for FEP, set strategy for QCR measures, ensure compliance with HEDIS/NCQA/URAC, manage cross-functional accreditation projects, develop programs to improve member care, oversee budgets, and lead a department to meet Plan and accreditor requirements.

Lead cross-functional accreditation projects for Federal Employee Program and Blue Plans. Serve as subject-matter expert for NCQA and URAC accreditation, develop submission documentation and tools, provide delegation oversight, conduct mock surveys, present accreditation guidance to plans, and translate trends into strategic action plans to ensure compliance and successful surveys.

Lead Trade-facing clinical and contract activities for manufacturer rebate programs. Advise Client Relations and Participants on PBM/UM policy, interpret manufacturer contracts, manage medical and pharmacy clinical policies for compliance, and collaborate cross-functionally to drive rebate program execution and clinical decision-making.

Lead brand strategy and support customer experience by translating research and consumer insights into strategic direction, creative briefs, and recommendations. Drive system-wide brand initiatives, partner with plans and cross-functional teams, and present strategy to leadership using AI-enabled tools to accelerate analysis and deliver aligned brand and marketing priorities.

The Director of Payment Integrity leads payment integrity strategy for BCBSA, ensuring competitive capabilities across commercial and government markets, advising on program requirements, and managing complex initiatives with a focus on performance monitoring and continuous improvement.