We are seeking an experienced Medicare Actuary to perform modeling and analysis for the Federal Employee Program Medicare Advantage and Part D Employer Group Waiver Program (MAPD/PDP EGWP). This role works independently primarily focusing on EGWP pricing, benefit design, CMS revenue, and risk adjustment, evaluating the financial implications of program and regulatory changes while supporting reserving, forecasting, and experience monitoring. The ideal candidate brings expertise in CMS payment mo...

Job Description Summary: The role develops strategies and solutions to address emerging product service requirements for national healthcare delivery for BCBSA programs. Provide product owner leadership to and interface between areas of BCBSA, Blue Plans and their customers, vendors and other business partners. Support the analysis and design of business models which address national market requirements, including operational processes, organization, human performance and financial impacts. Lea...

Job Description Summary: This role ensures the effectiveness and efficiency of the leadership by providing full range of administrative and project management support to the Executive and assigned team(s), exercising confidentiality, tact and diplomacy. Leads all efforts in providing information for internal and external inquiries regarding divisional activities, maintaining positive relations with internal and external contacts, including Member Plan CEOs and executives, federal government and...

Job Description Summary: The Account Executive serves as the primary contact and strategic liaison for assigned pharmacy clients, managing account performance across retail, mail, specialty, rebate, clinical, formulary, pharmacy benefit, and emerging solutions. Reporting to the Senior Vice President, Account Management, this role coordinates internal teams, operational support partners, PBMs, pharmacies, manufacturers, Clean Team resources, and vendors to deliver implementations, resolve issues...

Job Description Summary: Responsible for designing and implementing security solutions to protect an organization's systems and data. Assess security risks, develop security strategies, and ensure that security measures are integrated into all aspects of the organization's IT infrastructure. Additionally, provide guidance and leadership to security teams, conduct security audits, and stay up to date on the latest security threats and technologies. In this specific role the ideal candidate will...

Job Description Summary: This position is responsible for the design, development, and support of applications in available hybrid cloud environments. The role involves implementing stable, cloud-native applications and automating DevOps processes for provisioning, deployment, and monitoring activities in PaaS/IaaS environments. This specific role will serve as the senior technical authority for the Microsoft 365 platform, responsible for architecture, engineering, security, governance, automa...

Job Description Summary: This role is responsible for leading the development and directing the delivery of the financial / operational portion of the annual internal audit plan. The role directs multiple concurrent audit projects and supervises audit managers or staff to ensure that work progresses and meets quality standards. The role supports the leader with Internal Audit Department administrative oversight, strategic improvement initiatives (including the evaluation and deployment of arti...

The role is responsible for supporting business leads in the development and maintenance of various initiatives. This role includes coordinating small-scale cross-functional projects and supporting larger-scale initiatives. The coordinator oversees the coordination and status reporting of cross-functional project work, governance activities, and tracking corporate goals. Support the delivery of initiatives and resolve issues through design, development, and implementation, aid in the administra...

Job Description Summary: This role is responsible for leading and managing small to mid-size projects and portions of larger projects addressing critical strategic issues for the Blue System. The role is responsible for applying analytical rigor (e.g., data collection and analysis) and executing primary and secondary research, including BCBS Plan input. The position will be able to identify actionable insights and share with non-technical audiences, including senior leadership. The role require...

Job Description Summary: We are seeking a Product Analyst to partner with product managers, directors, and engineering teams to drive data-informed product strategy. This role bridges business and technical domains, transforming requirements into user stories, conducting in-depth analysis, and delivering insights that shape product roadmaps. The Product Analyst will use data, visualization, and market research to identify opportunities, optimize product experiences, and ensure BHI delivers val...

The Senior Director, Medicare Performance Hub (MPH) is a leadership role within the Blue Cross Blue Shield Association (BCBSA) Medicare business operations team. This individual will serve as the primary programmatic owner and operational lead for the MPH - a core enabling function designed to drive performance improvement in the areas of Star Ratings, Risk Adjustment, and Medical Cost Management. The MPH leader will oversee the build-out, operationalization, and ongoing governance of the Hub, ...

This role will: - Lead the creation and deployment of defined and structured processes to support evolving and maintaining the cyber risk management program. Work across the BCBSA organization to align cyber risk management with the organization's goals and outcomes. -Utilize both analytical and qualitative assessment approaches to identify, assess, and develop appropriate mitigation plans and strategies. -Apply experience to effectively manage cyber risk at technical and non-technical levels...