Strategic Account Manager - Stellarus, Principal Blue Cross and Blue Shield AssociationStrategic Account Manager - Stellarus, PrincipalGAThe Strategic Account Manager - Stellarus, Principal is a senior individual‑contributor role responsible for managing and growing a portfolio of strategic customer accounts that are important to Stellarus' growth and customer outcomes, but do not carry the same enterprise‑level risk or visibility as flagship accounts. In this role, you will serve as the primary account owner for assigned strategic customers, developing account strategies, driving value realization and solution adoption, and partnering across Product, Technology, and Operations teams to deliver measurable business outcomes.
Senior Director, Sales Executive - IFP Blue Cross and Blue Shield AssociationSenior Director, Sales Executive - IFPSan Diego, CAPosition Blue Shield advantageously in the evolving distribution channel landscape, including Covered California, brokers, agency online marketplaces or quoting engines, integrated enrollment platforms, and ICHRA or employer-sponsored enrollment platforms - as well as evaluating other strategic partners or paths Blue Shield of California should pursue. Work with internal partners who provide direct and indirect support to the channel landscape - including Producer Services, IT, Enrollment, Operations -to ensure capabilities, processes, and service models are aligned to support effective sales execution, operational readiness, and a channel partner experience.
Corporate Security Specialist (Part-time) Blue Cross and Blue Shield AssociationCorporate Security Specialist (Part-time)Des Moines, IA2+ years of experience in a security role, preferably within a corporate environment or a related security/protective services role; or equivalent training or experience (i.e. military or law enforcement training and experience). If you're passionate about joining an organization working hard to put its members first, to provide best-in-class service, and one that is committed to sustainability and innovation, consider applying today!
Product Strategist, Consultant - Small Business Blue Cross and Blue Shield AssociationProduct Strategist, Consultant - Small BusinessEl Dorado Hills, CAPortfolio Management and Execution: Manage the day-to-day maintenance of assigned product portfolios, including strategic, regulatory, and market-driven updates to product designs, benefits, cost shares, and customer experience offerings. Prepare strategic initiatives for implementation and support post-launch monitoring by ensuring accurate product information across systems, filings, communications, and operational processes while identifying and addressing performance or implementation issues.
Sr. Manager, Identity Platform Engineering Blue Cross and Blue Shield AssociationSr. Manager, Identity Platform EngineeringWashington, DCLeverage AI, machine learning, and intelligent automation to improve identity operations, entitlement analysis, access reviews, anomaly detection, governance, audit readiness, operational insights, developer support, engineering productivity, and compliance with HIPAA, SOX, HITRUST, NIST, audit requirements, and Zero Trust principles. Advance privileged access modernization and access governance through automated approval workflows, time-bound elevation, break-glass controls, credential rotation, session monitoring, access expiration, entitlement management, access certification, analytics, and risk-based privilege management.
Vendor Management Coordinator - Hybrid Blue Cross and Blue Shield AssociationVendor Management Coordinator - HybridPhoenix, AZThis position partners with internal business areas and vendors to provide transparency into vendor spend, validate financial accuracy, and identify opportunities for cost savings and overall performance improvement. The primary responsibility of this position is to support vendor management activities with a focus on financial oversight, operational performance, and service delivery monitoring in partnership with the BPO Oversight Specialists.
Mgr - Trading Partner Strategy - Hybrid Blue Cross and Blue Shield AssociationMgr - Trading Partner Strategy - HybridPhoenix, AZOwns the Edifecs EDI platform health, governance, and vendor relationship - including monitoring and alerting, SLA/KPI management, license tracking and management, capacity management, technical debt management, and any discipline that drives operational maturity and prevents outages. Serves as the cross-pillar operational excellence leader within TPDM, absorbing complexity that spans the EDI, ETL, and Delivery pillars; owning the TPDM Intake & Triage process; and driving strategic initiatives to completion.
RN II, -Pediatrics Case Manager-REMOTE Blue Cross and Blue Shield AssociationRN II, -Pediatrics Case Manager-REMOTENewark, NJRemote$79,100–$105,945 / yearThis compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation decisions, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity. This position is responsible for performing RN duties for the Primary Nurse population using established guidelines to ensure appropriate level of care, as well as, planning for the transition to the continuum of care and developing a member centric plan of care.
Information Security Engineer, Principal Blue Cross and Blue Shield AssociationInformation Security Engineer, PrincipalSan Diego, CAThis role partners closely with development teams, providing security oversight at each stage of the Software Development Lifecycle while enabling the business to operate securely at scale. This role requires employees to be in - office based on our hybrid workplace model, balancing purposeful in - person collaboration with flexibility.
Project Manager Blue Cross and Blue Shield AssociationProject ManagerHarrisburg, PASkills: Strong interpersonal and communication skills (with proven ability to deliver reports and presentations); ability to influence colleagues to build relationships; guide and inspire team members to deliver project work on time on budget, in accordance with internal guidelines and governance. Project Managers are expected to, run a variety of projects (small to very large), with a range of budget ($50,000 to multi -million dollars) and team sizes, across different areas of the organization with ease.
Manager - Operations-(AHNJ) Hybrid Blue Cross and Blue Shield AssociationManager - Operations-(AHNJ) HybridPhiladelphia, PAThe applicant will also have experience demonstrating the courage to honestly lead difficult conversations, coupled with the sensitivity and talent to constructively engage partners to deliver solutions for our customers, clients, brokers, and providers. Must have the ability to manage the area of responsibility and possess managerial skills necessary for organizing, planning, controlling, budgeting, developing and motivating employees in the accomplishment of assigned tasks.
Associate Product Owner - Pharmacy Operational Efficiency (Open to hiring at the Product Owner level) Blue Cross and Blue Shield AssociationAssociate Product Owner - Pharmacy Operational Efficiency (Open to hiring at the Product Owner level)Des Moines, IAApply change management practices and tools in pre-planning and planning (features and user stories) to ensure impacted stakeholders and employees are prepared and equipped to adopt changes; consult with the Change Practitioner supporting Agile Release Train (ART) to monitor change readiness and adoption across the ART. The role will work closely with various business and agile teams and will need to effectively collaborate, build consensus, and drive initiatives with key support teams across multiple departments, as well as partner with various Product teams and ARTs.
RN II (Field Based - Somerset County) Blue Cross and Blue Shield AssociationRN II (Field Based - Somerset County)Hopewell, NJ$79,100–$105,945 / yearThis compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation decisions, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity. Knowledge: Proficiency in the use of personal computers and supporting software in a Windows based environment, including MS Office products (Word, Excel,PowerPoint) and Lotus Notes; prefers knowledge in the use of intranet and internet applications.
Accountant, Consultant Blue Cross and Blue Shield AssociationAccountant, ConsultantOakland, CAYou will help enhance close, reconciliation, and reporting processes through automation and continuous improvement, partnering closely with Technology and cross-functional teams to modernize workflows, reduce manual effort, strengthen internal controls, and improve the timeliness and quality of financial reporting. Demonstrated experience with process automation, continuous improvement, and accounting systems optimization in an accounting or finance environment; consulting experience with system implementations is highly desirable.
Supervisor, Provider Disputes Blue Cross and Blue Shield AssociationSupervisor, Provider DisputesBaton Rouge, LAPursuant with sec 1033 of the Violent Crime Control and Law Enforcement Act of 1994, individuals who have been convicted of a felony crime involving dishonesty or breach of trust are prohibited from working in the insurance industry unless they obtain written consent from their state insurance commissioner. Necessary Contacts: In order to effectively fulfill this position, this position must be in contact with: Various internal and external entities including, but not limited to, all levels of BCBSLA personnel, attorneys, group leaders, members, hospitals, physician offices, and DOI.
Director, Network Operations Blue Cross and Blue Shield AssociationDirector, Network OperationsLong Beach, CAReporting to the Vice President, Network Operations, the Director, Network Operations plays a leadership role, guiding data-driven contracting approaches to improve provider network effectiveness while aligning and executing operational initiatives and governance to serve Blue Shield of California and Blue Shield of California Promise Health Plan''s (collectively "Blue Shield") best interests. This work ensures provider contract alignment, supports financial stewardship, strengthens enterprise governance, and advances strategic priorities across multiple lines of business.
Data Science Consultant - Generative AI (Open to hiring at Sr. Data Science Consultant level) Blue Cross and Blue Shield AssociationData Science Consultant - Generative AI (Open to hiring at Sr. Data Science Consultant level)Des Moines, IABachelor's degree in quantitative discipline such as statistics, mathematics, finance, accounting, computer science, engineering or economics and 2 years equivalent work experience with specific experience in the analysis of databases and files using SQL dialects and statistical programming languages with specific experience utilizing data collection, advanced formulas, advanced joins, analysis, statistics, and data presentation. Required: For consideration, you must meet one of the following educational/technical requirements: Master's degree in quantitative discipline such as statistics, mathematics, finance, accounting, computer science, engineering, or economics - OR.
Medical Director Behavioral Health Blue Cross and Blue Shield AssociationMedical Director Behavioral HealthHarrisburg, PAThis position will provide physician leadership and support to Capital's behavioral health (BH) program, As a clinical leader in mental health and substance use disorders, this position will collaborate cross-departmentally (internally) and with key external stakeholders, including Capital's network providers, to provide BH expertise and drive Triple Aim outcomes in support of Whole Person Care. Provides clinical leadership to the development and evolution of strategies to improve access and availability of BH care and services to Capital members, including physical and BH integration models (collaborative care models) and integrated care management programs among others.
Medical Director (Medicaid Segment) - Remote-AZ Blue Cross and Blue Shield AssociationMedical Director (Medicaid Segment) - Remote-AZPhoenix, AZRemoteProvide professional oversight for the various clinical peer committees including, but not limited to, the Clinical Quality Improvement Committee, Credentialing Committee, Medical Directors Committee, and Medical Management Committee. Work to ensure productive relationships with all customers, employers, members, and providers to ensure members receive the appropriate health care in the most appropriate setting with the best value in health care.
Information Security Risk and Governance Specialist, Consultant Blue Cross and Blue Shield AssociationInformation Security Risk and Governance Specialist, ConsultantSan Diego, CAIn this role, you will be a key individual contributor to the Technology Risk and External Assurance team and Blue Shield's overall strategy and goals by providing consistent, coordinated technology governance, information security oversight, AI governance, technology risk assessment, and risk reporting in partnership with leaders, stakeholders, and Stellarus. Partner with cross functional operational business partners including Customer Experience, Customer Care, Markets, Health Solutions and Enterprise Risk Management to operationalize and socialize the IT risk management framework and program and to identify shifts in the organization''s implicit risk appetite.
Sr. Manager, Identity Platform Engineering Blue Cross and Blue Shield AssociationSr. Manager, Identity Platform EngineeringHartford, CTLeverage AI, machine learning, and intelligent automation to improve identity operations, entitlement analysis, access reviews, anomaly detection, governance, audit readiness, operational insights, developer support, engineering productivity, and compliance with HIPAA, SOX, HITRUST, NIST, audit requirements, and Zero Trust principles. Advance privileged access modernization and access governance through automated approval workflows, time-bound elevation, break-glass controls, credential rotation, session monitoring, access expiration, entitlement management, access certification, analytics, and risk-based privilege management.
Sr. Manager, Identity Platform Engineering Blue Cross and Blue Shield AssociationSr. Manager, Identity Platform EngineeringRichmond, VALeverage AI, machine learning, and intelligent automation to improve identity operations, entitlement analysis, access reviews, anomaly detection, governance, audit readiness, operational insights, developer support, engineering productivity, and compliance with HIPAA, SOX, HITRUST, NIST, audit requirements, and Zero Trust principles. Advance privileged access modernization and access governance through automated approval workflows, time-bound elevation, break-glass controls, credential rotation, session monitoring, access expiration, entitlement management, access certification, analytics, and risk-based privilege management.
Product Strategist, Consultant - Small Business Blue Cross and Blue Shield AssociationProduct Strategist, Consultant - Small BusinessWoodland Hills, CAPortfolio Management and Execution: Manage the day-to-day maintenance of assigned product portfolios, including strategic, regulatory, and market-driven updates to product designs, benefits, cost shares, and customer experience offerings. Prepare strategic initiatives for implementation and support post-launch monitoring by ensuring accurate product information across systems, filings, communications, and operational processes while identifying and addressing performance or implementation issues.
Sr. Manager, Identity Platform Engineering Blue Cross and Blue Shield AssociationSr. Manager, Identity Platform EngineeringBaltimore, MDLeverage AI, machine learning, and intelligent automation to improve identity operations, entitlement analysis, access reviews, anomaly detection, governance, audit readiness, operational insights, developer support, engineering productivity, and compliance with HIPAA, SOX, HITRUST, NIST, audit requirements, and Zero Trust principles. Advance privileged access modernization and access governance through automated approval workflows, time-bound elevation, break-glass controls, credential rotation, session monitoring, access expiration, entitlement management, access certification, analytics, and risk-based privilege management.
Specialist, Change Mgt & Business Readiness Blue Cross and Blue Shield AssociationSpecialist, Change Mgt & Business ReadinessNewark, NJ$109,600–$149,625 / yearWorking closely with Operations, EBTS, Training, Communications, and business leaders, this position develops and executes comprehensive change management strategies that minimize disruption, mitigate risk, and maximize business value. This compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation decisions, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity.
Sr. Manager, Identity Platform Engineering Blue Cross and Blue Shield AssociationSr. Manager, Identity Platform EngineeringDenver, COLeverage AI, machine learning, and intelligent automation to improve identity operations, entitlement analysis, access reviews, anomaly detection, governance, audit readiness, operational insights, developer support, engineering productivity, and compliance with HIPAA, SOX, HITRUST, NIST, audit requirements, and Zero Trust principles. Advance privileged access modernization and access governance through automated approval workflows, time-bound elevation, break-glass controls, credential rotation, session monitoring, access expiration, entitlement management, access certification, analytics, and risk-based privilege management.
Sr. Manager, Identity Platform Engineering Blue Cross and Blue Shield AssociationSr. Manager, Identity Platform EngineeringSeattle, WALeverage AI, machine learning, and intelligent automation to improve identity operations, entitlement analysis, access reviews, anomaly detection, governance, audit readiness, operational insights, developer support, engineering productivity, and compliance with HIPAA, SOX, HITRUST, NIST, audit requirements, and Zero Trust principles. Advance privileged access modernization and access governance through automated approval workflows, time-bound elevation, break-glass controls, credential rotation, session monitoring, access expiration, entitlement management, access certification, analytics, and risk-based privilege management.
Sr. Manager, Identity Platform Engineering Blue Cross and Blue Shield AssociationSr. Manager, Identity Platform EngineeringSan Diego, CALeverage AI, machine learning, and intelligent automation to improve identity operations, entitlement analysis, access reviews, anomaly detection, governance, audit readiness, operational insights, developer support, engineering productivity, and compliance with HIPAA, SOX, HITRUST, NIST, audit requirements, and Zero Trust principles. Advance privileged access modernization and access governance through automated approval workflows, time-bound elevation, break-glass controls, credential rotation, session monitoring, access expiration, entitlement management, access certification, analytics, and risk-based privilege management.
Sr. Manager, Identity Platform Engineering Blue Cross and Blue Shield AssociationSr. Manager, Identity Platform EngineeringPhoenix, AZLeverage AI, machine learning, and intelligent automation to improve identity operations, entitlement analysis, access reviews, anomaly detection, governance, audit readiness, operational insights, developer support, engineering productivity, and compliance with HIPAA, SOX, HITRUST, NIST, audit requirements, and Zero Trust principles. Advance privileged access modernization and access governance through automated approval workflows, time-bound elevation, break-glass controls, credential rotation, session monitoring, access expiration, entitlement management, access certification, analytics, and risk-based privilege management.
Sr. Manager, Identity Platform Engineering Blue Cross and Blue Shield AssociationSr. Manager, Identity Platform EngineeringAtlanta, GALeverage AI, machine learning, and intelligent automation to improve identity operations, entitlement analysis, access reviews, anomaly detection, governance, audit readiness, operational insights, developer support, engineering productivity, and compliance with HIPAA, SOX, HITRUST, NIST, audit requirements, and Zero Trust principles. Advance privileged access modernization and access governance through automated approval workflows, time-bound elevation, break-glass controls, credential rotation, session monitoring, access expiration, entitlement management, access certification, analytics, and risk-based privilege management.
Sr. Manager, Identity Platform Engineering Blue Cross and Blue Shield AssociationSr. Manager, Identity Platform EngineeringLas Vegas, NVLeverage AI, machine learning, and intelligent automation to improve identity operations, entitlement analysis, access reviews, anomaly detection, governance, audit readiness, operational insights, developer support, engineering productivity, and compliance with HIPAA, SOX, HITRUST, NIST, audit requirements, and Zero Trust principles. Advance privileged access modernization and access governance through automated approval workflows, time-bound elevation, break-glass controls, credential rotation, session monitoring, access expiration, entitlement management, access certification, analytics, and risk-based privilege management.
Specialist, Business Systems Analyst II Blue Cross and Blue Shield AssociationSpecialist, Business Systems Analyst IINewark, NJ$109,600–$149,625 / yearServe as the primary Business Systems Analyst for Blue Card, BlueCard Modernization (BCM), National Program Releases (NPR), Inter-Plan Teleprocessing System (ITS), Blue2, BlueCard Portal, RTM, and related BCBSA initiatives. This compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation decisions, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity.
Actuarial Analyst II Blue Cross and Blue Shield AssociationActuarial Analyst IINewark, NJ$79,100–$105,945 / yearThe role is responsible for supporting the evaluation of proposed benefit and cost-sharing changes, conducting pricing studies, assessing the impact of state and federal legislative changes, and contributing to various actuarial initiatives. This compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation decisions, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity.
Information Security Risk and Governance Specialist, Consultant Blue Cross and Blue Shield AssociationInformation Security Risk and Governance Specialist, ConsultantLong Beach, CAIn this role, you will be a key individual contributor to the Technology Risk and External Assurance team and Blue Shield's overall strategy and goals by providing consistent, coordinated technology governance, information security oversight, AI governance, technology risk assessment, and risk reporting in partnership with leaders, stakeholders, and Stellarus. Partner with cross functional operational business partners including Customer Experience, Customer Care, Markets, Health Solutions and Enterprise Risk Management to operationalize and socialize the IT risk management framework and program and to identify shifts in the organization''s implicit risk appetite.
Information Security Engineer, Principal Blue Cross and Blue Shield AssociationInformation Security Engineer, PrincipalWoodland Hills, CAThis role partners closely with development teams, providing security oversight at each stage of the Software Development Lifecycle while enabling the business to operate securely at scale. This role requires employees to be in - office based on our hybrid workplace model, balancing purposeful in - person collaboration with flexibility.
Network Reimbursement Analyst II Blue Cross and Blue Shield AssociationNetwork Reimbursement Analyst IIHarrisburg, PAThe Network Reimbursement Analyst works with the team manager and other analysts from within the same unit to develop and administer pricing for contracts between Capital BlueCross and various providers of health care services, including professional providers, hospitals, non-hospital providers and ancillary providers. Acts as an advisor for the Network Provider Contracting and Network Analytics and Contract Support teams to answer questions relating to payment and system configuration around fee schedules and facility reimbursement to determine the urgency and importance of system change requests/problems.
Care Management - Nurse, Senior Blue Cross and Blue Shield AssociationCare Management - Nurse, SeniorLong Beach, CAThe Care Management team independently manages complex and high-risk care management cases by applying advanced clinical judgment to assess medical necessity, develop cost-effective care plans, and support quality outcomes aligned with benefit and contract requirements. You will collaborate with providers, medical directors, and interdisciplinary teams to coordinate care, support discharge planning, evaluate barriers to care, and ensure members receive appropriate referrals and continuity of treatment.
Care Management - Nurse, Senior Blue Cross and Blue Shield AssociationCare Management - Nurse, SeniorEl Dorado Hills, CAThe Care Management team independently manages complex and high-risk care management cases by applying advanced clinical judgment to assess medical necessity, develop cost-effective care plans, and support quality outcomes aligned with benefit and contract requirements. You will collaborate with providers, medical directors, and interdisciplinary teams to coordinate care, support discharge planning, evaluate barriers to care, and ensure members receive appropriate referrals and continuity of treatment.
Internal Controls Consulting, Consultant Blue Cross and Blue Shield AssociationInternal Controls Consulting, ConsultantLodi, CAThe team helps Blue Shield of California accomplish its objectives by providing enterprise-wide oversight, advisory, testing, and monitoring while partnering with business functions that retain accountability for control execution and effectiveness. Perform end‑to‑end internal control assessments, including evaluating control design and effectiveness, analyzing evidence, and documenting processes, risks, and issues across financial, operational and vendor/third-parties processes.
Director, Community & Local Government Engagement - Medi-Cal Blue Cross and Blue Shield AssociationDirector, Community & Local Government Engagement - Medi-CalLong Beach, CAThe Director of Community and Local Government Engagement will report to the Blue Shield Promise Senior Director of Public Programs and Stakeholder Engagement and has responsibility for integrating plans with senior leaders across Government Affairs, External Communications/PR, Internal Communications, and Lines of Business leadership. Requires at least 5 years of experience working in government affairs, public relations, health policy communications, and/or health advocacy and demonstrates strong political savvy skills to successfully represent Blue Shield Promise with local elected officials, community and industry groups - preferably in Los Angeles County.
Sr. Director, Tax Accounting Blue Cross and Blue Shield AssociationSr. Director, Tax AccountingRancho Cordova, CAIn this role, you will: Set and lead enterprise-wide tax strategy, compliance operations, and the multi-year roadmap for the organization and its family of companies, defining priorities, funding, and governance to deliver accurate provision, compliance, and internal control outcomes while ensuring adherence to federal, state, and local tax requirements and enabling growth across expanding markets. Serve as the enterprise tax leader and cross-functional advisor to Finance, Legal, HR, Treasury, Operations, Payroll, and Technology by aligning stakeholders on complex regulatory and business matters, resolving escalations, securing commitments, and driving decisions that strengthen financial integrity, compliance, and business outcomes.
Internal Controls Consulting, Consultant Blue Cross and Blue Shield AssociationInternal Controls Consulting, ConsultantOakland, CAThe team helps Blue Shield of California accomplish its objectives by providing enterprise-wide oversight, advisory, testing, and monitoring while partnering with business functions that retain accountability for control execution and effectiveness. Perform end‑to‑end internal control assessments, including evaluating control design and effectiveness, analyzing evidence, and documenting processes, risks, and issues across financial, operational and vendor/third-parties processes.
Internal Controls Consulting, Consultant Blue Cross and Blue Shield AssociationInternal Controls Consulting, ConsultantRancho Cordova, CAThe team helps Blue Shield of California accomplish its objectives by providing enterprise-wide oversight, advisory, testing, and monitoring while partnering with business functions that retain accountability for control execution and effectiveness. Perform end‑to‑end internal control assessments, including evaluating control design and effectiveness, analyzing evidence, and documenting processes, risks, and issues across financial, operational and vendor/third-parties processes.
Care Management - Nurse, Senior Blue Cross and Blue Shield AssociationCare Management - Nurse, SeniorWoodland Hills, CAThe Care Management team independently manages complex and high-risk care management cases by applying advanced clinical judgment to assess medical necessity, develop cost-effective care plans, and support quality outcomes aligned with benefit and contract requirements. You will collaborate with providers, medical directors, and interdisciplinary teams to coordinate care, support discharge planning, evaluate barriers to care, and ensure members receive appropriate referrals and continuity of treatment.
Sr. Manager, Program and Project Management- Pharmacy Accounts and Sales Support Blue Cross and Blue Shield AssociationSr. Manager, Program and Project Management- Pharmacy Accounts and Sales SupportOakland, CAAdditionally, this role is responsible for the leadership of the pharmacy accounts and sales support team to support employer group account management and client renewal, as well as new membership acquisition activities for fully insured and self-funded pharmacy membership. Manage team to provide pharmacy consultative support, and support development of training tools, presentations, sales collaterals on pharmacy product offerings and value proposition as needed to support sales.
AI Auditor, Senior Blue Cross and Blue Shield AssociationAI Auditor, SeniorLodi, CAThe AI Internal Audit Consultant will help evaluate AI activity, system usage, data flows, prompts, outputs, logs, access patterns, process documentation, and control evidence to identify suspicious behavior, potential compliance violations, fraud indicators, or inappropriate use of AI tools. Requires a minimum of 5 years of prior related experience in internal audit, IT audit, technology risk, compliance, fraud detection, investigations, information security, data governance, data analytics, model risk management, or related assurance functions.
Medical Informatics Analyst, Consultant- Utilization Management Blue Cross and Blue Shield AssociationMedical Informatics Analyst, Consultant- Utilization ManagementLodi, CAThe Healthcare Quality Affordability (HQA) Analytics team plays a key role in discovering information hidden in vast amounts of data that can lead to smarter decisions and deliver better service for our customers and contain the rising cost of healthcare. Provide training and mentoring for team members on best practices for analysis and reporting; assist in the development of supplemental analytic training tools and materials; conducts formal training sessions for lower level analysts and analysts in other Departments.
AI Auditor, Principal Blue Cross and Blue Shield AssociationAI Auditor, PrincipalSan Diego, CAThe AI Internal Audit Principal will partner closely with audit leadership, business stakeholders, technology teams, data science teams, Compliance, Legal, HR, Privacy, Information Security, Corporate Security, and investigations partners to identify AI-related fraud risks, detect suspicious activity, and strengthen controls that prevent, identify, and respond to misuse of AI. Requires a minimum of 10 years of prior related experience in internal audit, IT audit, technology risk, compliance, fraud detection, investigations, information security, data governance, model risk management, or related assurance functions.
Care Navigator- Deer Valley Clinic (Bilingual English/Mandarin) (Onsite) Blue Cross and Blue Shield AssociationCare Navigator- Deer Valley Clinic (Bilingual English/Mandarin) (Onsite)Phoenix, AZThe Clinical Care Guide will have end to end responsibility for our specialist and diagnostic testing navigation, as well as in leading and partnering with the care team to support patients in their journey toward their best health. About Prosano Health Solutions: Prosano Health Solutions, in partnership with Blue Cross Blue Shield of Arizona, has launched an Advanced Primary Care model with a clear mission: To Inspire Health and Make it Easy.
Information Security Risk and Governance Specialist, Consultant Blue Cross and Blue Shield AssociationInformation Security Risk and Governance Specialist, ConsultantWoodland Hills, CAIn this role, you will be a key individual contributor to the Technology Risk and External Assurance team and Blue Shield's overall strategy and goals by providing consistent, coordinated technology governance, information security oversight, AI governance, technology risk assessment, and risk reporting in partnership with leaders, stakeholders, and Stellarus. Partner with cross functional operational business partners including Customer Experience, Customer Care, Markets, Health Solutions and Enterprise Risk Management to operationalize and socialize the IT risk management framework and program and to identify shifts in the organization''s implicit risk appetite.