Jobs at Blue Cross NC

Manage small programs or phases of larger programs, coordinating resources, schedules, budgets, vendors, contracts, reporting, evaluations, and process improvements. Monitor program performance, document outcomes, prepare presentations and reports, and implement changes to achieve program objectives. The role requires collaboration across stakeholders and oversight of program administration and operations.

Leads actuarial financial data systems and marts, developing data solutions, extracts, reports, analyses, automations, validations, and executive reporting support. Manages data mart maintenance, audits, business requirements, technical specifications, user acceptance testing, and system implementations. Provides technical leadership, coordinates vendors and departments, trains junior staff, and advises project teams on data architecture, business rules, configuration, and financial data quality.

Lead complex actuarial projects focused on ACA risk adjustment, pricing, forecasting, and competitive benchmarking. Provide strategic actuarial guidance, manage vendor and regulator relationships, achieve financial targets, and communicate results to senior leadership while maintaining actuarial credentials.

Provides advanced analytical support for ACA risk adjustment, including model implementation, RAF validation, forecasting, reporting, reconciliation, and discrepancy analysis. Uses SQL and Python to analyze healthcare data, improve recurring processes, develop controls, and support regulatory and financial activities. Partners with actuarial, regulatory, finance, operational, provider, and vendor stakeholders; presents findings and recommendations; maintains analytical applications; and mentors less experienced employees.

Support actuarial teams with rating, pricing, valuation, and forecasting for health programs. Perform data retrieval/validation, experience studies, statistical analyses, ALR/UCL calculations, rate filings, and reporting. Collaborate with underwriting, network, finance, and other stakeholders and participate in the Actuarial Development Program.

Lead short-, medium-, and long-term cash flow forecasting; analyze liquidity trends, risks, and opportunities; communicate actionable insights to senior management and the Board; partner with Finance, Treasury, Actuarial, Investments, and business leaders; and optimize excess cash according to investment policies.

Provides audit and risk advisory services across subsidiaries, focusing on financial, strategic, and entity-level risks and controls. Performs walkthroughs, control testing, process analysis, audits, deficiency assessments, remediation validation, and advisory engagements. Uses COSO and related frameworks to strengthen governance and internal controls, develops mitigation strategies, documents findings, trains management, and prepares audit reports.

Prepare and review financial statements, coordinate month-end close and reporting, analyze complex accounting information, resolve GAAP/SAP issues, maintain controls, support audits, and recommend process improvements. Provide technical guidance, coach colleagues, conduct due diligence, evaluate deal structures, and participate in cross-functional finance projects. The role requires collaboration with auditors, other Blue Cross plans, and the BCBSA.

Supports commercial reserving through actuarial research, experience studies, statistical analysis, premium and reserve calculations, valuation, rate filings, reporting, and healthcare analytics. The role validates data, enhances actuarial models, investigates trends, supports regulatory submissions and enterprise risk management, and provides analytical support to internal business partners. Candidates need a degree, actuarial experience, and at least three exams toward the ASA designation, with alternatives considered for additional experience or exams.

Provides legal counsel for pharmacy benefit management and State Health Plan operations. Responsibilities include interpreting PBM contracts, advising on state and federal health plan regulations, supporting vendor oversight, privacy and data governance, audits, public records requests, claims and appeals, regulatory inquiries, and implementation initiatives. The role also monitors legal developments, trains stakeholders, and helps manage contractual, compliance, and operational risks.

Leads strategic sourcing, category management, vendor governance, contract negotiations, supplier relationship management, risk assessments, and compliance for IT hardware, software, and services. Develops sourcing strategies, bid documents, evaluation criteria, vendor plans, performance metrics, and total-cost optimization recommendations. Partners with stakeholders, Legal, Compliance, Audit, Risk Management, and vendors to resolve contractual issues and improve procurement processes.

Develops technical business solutions, automation tools, reports, and productivity improvements using applications such as SQL, VBA, Business Objects, and Tableau. Analyzes requirements, gathers business needs, tests and debugs code, coordinates projects, manages implementation plans, documents solutions, trains users, and provides post-implementation support. Acts as a technical lead and consultative partner across business areas while ensuring adherence to standards and service-level agreements.

Lead design, development, and delivery of ML, DL, and Generative AI systems for production. Apply prescriptive analytics, optimization, recommendation, and reinforcement learning. Build and evaluate models, run experiments, develop prototypes, benchmark methods, and collaborate with business partners to translate data into actionable recommendations and influence strategy.