Commercial Sales Operations, Principal - Stellarus Blue Shield of CACommercial Sales Operations, Principal - StellarusSeattle, WAFull timeThis role partners closely with Sales Development, Sales Leadership, Marketing, Finance, and Product to design and maintain the infrastructure, processes, and analytical frameworks that enable predictable growth. Requires experience partnering crossfunctionally with Sales, Sales Development, Marketing, Finance, Legal, and Deal Desk teams to streamline deal cycles and improve operational efficiency.
Housekeeper Blue Cross & Blue Shield of MississippiHousekeeperFlowood, MississippiVarious cleaning activities such as vacuuming, dusting, disinfecting, emptying trash, cleaning restrooms, offices and conference rooms are included. This position is responsible to perform various janitorial services in all BCBSMS buildings including the Executive building.
Cashier Blue Cross & Blue Shield of MississippiCashierFlowood, MississippiAdditional responsibilities include, but are not limited to, food preparation, setting up serving areas and serving employees, and cleaning the Blues Café area, utensils, and equipment. The Cashier is responsible for following cash/credit tendering procedures to ensure that monies are secured and accounted for and that cafeteria sales are accurately transacted.
Associate Inbound Concierge Agent Blue Cross & Blue Shield of Rhode IslandAssociate Inbound Concierge AgentProvidence, Rhode IslandTo further improve the health and well-being of our fellow Rhode Islanders, we regularly roll up our sleeves and get to work (literally) in communities all across the state—building homes, working in food pantries, revitalizing community centers, and transforming outdoor spaces for children and adults. Permitted to reside in the following states, pending approval from the Human Resources Department: Arizona, Connecticut, Florida, Georgia, Louisiana, Massachusetts, North Carolina, Oklahoma, Rhode Island, South Carolina, Texas, Virginia.
Manager, Member Marketing & Sales Support Blue Shield of North CarolinaManager, Member Marketing & Sales SupportDurham, North CarolinaThe Manager, Member Marketing & Sales Support is responsible for planning and executing member-facing marketing programs that drive onboarding, engagement, retention, and healthcare program adoption, while also delivering marketing support for Sales and distribution partners. Competitor Analysis, Customer Acquisition Strategy, Demand Generation, Direct Marketing, Identifying Opportunities, Lead Generation, Marketing, Marketing Strategies, Market Research, Performance Metrics, Sales Process, Stakeholder Management, Strategic Planning_____________________________________________________________________.
Care Management Support Specialist Blue Cross and Blue Shield of Kansas CityCare Management Support SpecialistKSThe Care Management Support Specialist partners closely with Care Management nurses, Quality and Community Health teams, and external vendor partners to manage referrals, support member onboarding into Care Management, resolve operational barriers, and ensure smooth day-to-day program operations. Embedded within the Care Management department, this role supports efficient and effective digital and telephonic workflows that enable timely outreach, accurate routing, documentation completeness, and audit readiness, allowing licensed clinicians to focus on clinical assessment, care planning, and interventions.
Care Management Support Specialist Blue Cross and Blue Shield of Kansas CityCare Management Support SpecialistMOThe Care Management Support Specialist partners closely with Care Management nurses, Quality and Community Health teams, and external vendor partners to manage referrals, support member onboarding into Care Management, resolve operational barriers, and ensure smooth day-to-day program operations. Embedded within the Care Management department, this role supports efficient and effective digital and telephonic workflows that enable timely outreach, accurate routing, documentation completeness, and audit readiness, allowing licensed clinicians to focus on clinical assessment, care planning, and interventions.
Broker Data Delivery Analyst Blue Cross Blue Shield of ArizonaBroker Data Delivery AnalystPhoenix, ArizonaRemoteServes as the primary technical and analytical resource responsible for understanding how member, policy, premium, and agent assignment data flows from source systems into SAP Agent Performance Management (Callidus/APM), and how that data is used organizationally across commission processing, broker portal display, book of business management, and enterprise reporting. Serves as the Broker Commissions data SME for the broker portal, providing data clarification, analysis, and requirements support to Digital Product, IT, and portal project teams regarding how Callidus data drives portal content, including commission statements, book of business, and agent/firm relationships.
NewCustomer Advocate Phone Specialist - BC Home- Hybrid Blue Cross Blue Shield of ArizonaCustomer Advocate Phone Specialist - BC Home- HybridPhoenix, ArizonaAZ Blue offers a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions. Explain to customers a variety of information concerning the organization’s services, including but not limited to, contract benefits, changes in coverage, eligibility, claims, BCBSAZ programs, provider networks, etc.
Support Specialist Customer Service I Blue Cross and Blue Shield AssociationSupport Specialist Customer Service IJonesboro, ARAdministrative Support: Provides administrative support, which includes but not limited to handling incoming faxes, reporting, maintaining database, member correspondences, maintaining inventory supplies and marketing material, and orderly upkeep of retail store, supply closet and hospitality area. 1.1 General Office Worker, Sedentary, Campus Travel - Someone who normally works in an office setting or remotely and routinely travels for work within walking distance of location of primary work assignment.
Customer Service Rep I - MA Servicing (Detroit) C-S-R Blue Cross and Blue Shield AssociationCustomer Service Rep I - MA Servicing (Detroit) C-S-RDetroit, MIOne (1) year of related work experience in areas such as public/customer service, sales representative, claims processing, membership enrollment; or one (1) year of public contact in positions such as teaching, social service work, bank teller, medical assistant/office assistant. One (1) year of total related experience or in the absence of internal BCBSM experience, the following may apply: One (1) year of related work experience in areas such as public/customer service, sales representative or claims processing.
Customer Service Rep I (KLASC) Lansing - C-S-R Blue Cross and Blue Shield AssociationCustomer Service Rep I (KLASC) Lansing - C-S-RLansing, MIOne (1) year of related work experience in areas such as public/customer service, sales representative, claims processing, membership enrollment; or one (1) year of public contact in positions such as teaching, social service work, bank teller, medical assistant/office assistant. One (1) year of total related experience or in the absence of internal BCBSM experience, the following may apply: One (1) year of related work experience in areas such as public/customer service, sales representative or claims processing.
Self-Direction PPP Support Counselor (Field Based - Hudson County) Blue Cross and Blue Shield AssociationSelf-Direction PPP Support Counselor (Field Based - Hudson County)Hopewell, NJ$63,000–$84,420 / 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. The Support Coordinator will provide member assistance and strategic insight during the development and review of the member's cash management plan, budget performance, review of monthly results and to ensure the cash management plan is meeting the member's needs.
Self-Direction PPP Support Counselor (Field Based - Somerset County) Blue Cross and Blue Shield AssociationSelf-Direction PPP Support Counselor (Field Based - Somerset County)Hopewell, NJ$63,000–$84,420 / 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. The Support Counselor will provide member assistance and strategic insight during the development and review of the member's cash management plan, budget performance, review of monthly results and to ensure the cash management plan is meeting the member's needs.
Coding Solutions Specialist Blue Cross and Blue Shield AssociationCoding Solutions SpecialistCheyenne, WYDepending on the department and the position, eligible employees may be offered limited In-Office/WFH flexibility (for those positions that are offered limited WFH, there will be a required number of In-Office days per week/month depending on department). As a Coding Solutions Specialist at BCBSWY, you'll join an incredible team of sharp, collaborative professionals dedicated to keeping our medical policy coding, system programming, and appeals processes running with accuracy, efficiency, and innovation.
Self-Direction PPP Support Counselor (Field Based - Burlington County) Blue Cross and Blue Shield AssociationSelf-Direction PPP Support Counselor (Field Based - Burlington County)Hopewell, NJ$63,000–$84,420 / 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. The Support Counselor will provide member assistance and strategic insight during the development and review of the member's cash management plan, budget performance, review of monthly results and to ensure the cash management plan is meeting the member's needs.
Provider Relations Representative I (Hybrid) Blue Cross and Blue Shield AssociationProvider Relations Representative I (Hybrid)Baltimore, MD$49,248–$97,812 / yearPROJECT MANAGEMENT: Supports network projects and outreach initiatives that must be special handled by Provider Relations in order to mitigate risk to CareFirst, supplement existing technology, maintain critical operations, support corporate initiatives including but not limited to provider experience scores, STAR ratings, HEDIS measures, and CAHPS program. Provides communication, education, issue/dispute resolution and support of managing all of CareFirst''s contracted in-network providers including independent professional practices, health systems, hospitals, and ancillary providers across all lines of business.
Call Center Service Associate-7 Blue Cross and Blue Shield AssociationCall Center Service Associate-7Newark, NJ$47,961–$63,820 / 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. For over 90 years, we have been New Jersey's health solutions leader driving innovations that improve health care quality, affordability, and member experience.
Health Services Coding Analyst (CPC Required) Blue Cross and Blue Shield AssociationHealth Services Coding Analyst (CPC Required)Sioux Falls, SDRemoteWork directly with Health Services leadership, Medical Review staff, leadership within Claims and Customer/Provider Services and Network Engagement, Medical Directors to provide medical coding expertise and PGE rule knowledge to resolve complex claims and/or customer and provider issues. Contribute to the achievement of corporate and UM Product Team objectives by independently serving as primary points of contact and UM Product Team Subject Matter Expert/Guest Star to provide expertise to support the various claims processing systems, including but not limited to PGE rules and table maintenance (FACETS and STAR).
Health Services Coding Analyst (CPC Required) Blue Cross and Blue Shield AssociationHealth Services Coding Analyst (CPC Required)Des Moines, IARemoteWork directly with Health Services leadership, Medical Review staff, leadership within Claims and Customer/Provider Services and Network Engagement, Medical Directors to provide medical coding expertise and PGE rule knowledge to resolve complex claims and/or customer and provider issues. Contribute to the achievement of corporate and UM Product Team objectives by independently serving as primary points of contact and UM Product Team Subject Matter Expert/Guest Star to provide expertise to support the various claims processing systems, including but not limited to PGE rules and table maintenance (FACETS and STAR).
Health Services Coding Analyst (CPC Required) Blue Cross and Blue Shield AssociationHealth Services Coding Analyst (CPC Required)Cedar Rapids, IARemoteWork directly with Health Services leadership, Medical Review staff, leadership within Claims and Customer/Provider Services and Network Engagement, Medical Directors to provide medical coding expertise and PGE rule knowledge to resolve complex claims and/or customer and provider issues. Contribute to the achievement of corporate and UM Product Team objectives by independently serving as primary points of contact and UM Product Team Subject Matter Expert/Guest Star to provide expertise to support the various claims processing systems, including but not limited to PGE rules and table maintenance (FACETS and STAR).
Provider Relations Representative I (Hybrid) Blue Cross and Blue Shield AssociationProvider Relations Representative I (Hybrid)Baltimore, MD$49,464–$98,241 / yearPROJECT MANAGEMENT: Supports network projects and outreach initiatives that must be special handled by Provider Relations in order to mitigate risk to CareFirst, supplement existing technology, maintain critical operations, support corporate initiatives including but not limited to provider experience scores, STAR ratings, HEDIS measures, and CAHPS program. Provides communication, education, issue/dispute resolution and support of managing all of CareFirst''s contracted in-network providers including independent professional practices, health systems, hospitals, and ancillary providers across all lines of business.
Client Solutions Specialist Blue Cross and Blue Shield AssociationClient Solutions SpecialistPhiladelphia, PAAs a Client Solutions Specialist, you play a critical role in ensuring our clients and members receive prompt, accurate, and well-considered resolutions to complex issues. Join our dynamic team as a Client Solutions Specialist, where your critical thinking and problem-solving skills will drive meaningful changes for our clients and members.
Client Solutions Specialist Blue Cross and Blue Shield AssociationClient Solutions SpecialistPhiladelphia, PAAs a Client Solutions Specialist, you play a critical role in ensuring our clients and members receive prompt, accurate, and well-considered resolutions to complex issues. Join our dynamic team as a Client Solutions Specialist, where your critical thinking and problem-solving skills will drive meaningful changes for our clients and members.
Provider Relations Representative I (Hybrid) Blue Cross and Blue Shield AssociationProvider Relations Representative I (Hybrid)Baltimore, MD$49,464–$98,241 / yearPROJECT MANAGEMENT: Supports network projects and outreach initiatives that must be special handled by Provider Relations in order to mitigate risk to CareFirst, supplement existing technology, maintain critical operations, support corporate initiatives including but not limited to provider experience scores, STAR ratings, HEDIS measures, and CAHPS program. Provides communication, education, issue/dispute resolution and support of managing all of CareFirst''s contracted in-network providers including independent professional practices, health systems, hospitals, and ancillary providers across all lines of business.
Self-Direction PPP Support Counselor (Field Based - Mercer County) Blue Cross and Blue Shield AssociationSelf-Direction PPP Support Counselor (Field Based - Mercer County)Hopewell, NJ$63,000–$84,420 / 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. The Support Coordinator will provide member assistance and strategic insight during the development and review of the member's cash management plan, budget performance, review of monthly results and to ensure the cash management plan is meeting the member's needs.
Provider Relations Representative - Medicare Advantage Blue Cross and Blue Shield AssociationProvider Relations Representative - Medicare AdvantageCheyenne, WYTo be successful in this role, you will need to invest in learning our products and services, be dedicated to provider service, handle phone contact with providers and their office staff who may be experiencing a variety of situations, be comfortable accessing and utilizing multiple systems to respond and research provider inquiries and apply solid judgement as to when to escalate if needed. Depending on the department and the position, eligible employees may be offered limited In-Office/WFH flexibility (for those positions that are offered limited WFH, there will be a required number of In-Office days per week/month depending on department).
Self-Direction PPP Support Counselor (Field Based - Monmouth County) Blue Cross and Blue Shield AssociationSelf-Direction PPP Support Counselor (Field Based - Monmouth County)Hopewell, NJ$63,000–$84,420 / 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. The Support Counselor will provide member assistance and strategic insight during the development and review of the member's cash management plan, budget performance, review of monthly results and to ensure the cash management plan is meeting the member's needs.
Client Solutions Specialist Blue Cross and Blue Shield AssociationClient Solutions SpecialistPhiladelphia, PAAs a Client Solutions Specialist, you play a critical role in ensuring our clients and members receive prompt, accurate, and well-considered resolutions to complex issues. Join our dynamic team as a Client Solutions Specialist, where your critical thinking and problem-solving skills will drive meaningful changes for our clients and members.
Customer Service Advocate I - MD Medicaid (Remote) Blue Cross and Blue Shield AssociationCustomer Service Advocate I - MD Medicaid (Remote)MDRemote$32,256–$59,136 / yearUses knowledge of products and the contractual provisions that govern administration to provide customer service and education, to interpret contractual language to the customer for the purpose of providing benefit utilization and limitations, to determine the need for managed care initiatives, and to administer all types of services to customers within the business segment through telephonic inquiries, written and/or electronic inquiries and claims adjustments, if applicable. ESSENTIAL FUNCTIONS: Provides first- level problem resolution to member, provider & broker inquiries via telephone by gathering and researching information; examine claim submissions verifying claim and system accuracy as well as liability, validate customer understanding of information and resolves issues based on applicable policies and procedures.
Customer Advocate Phone Specialist - BC Home- Hybrid Blue Cross and Blue Shield AssociationCustomer Advocate Phone Specialist - BC Home- HybridPhoenix, AZAZ Blue offers a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions. Explain to customers a variety of information concerning the organization's services, including but not limited to, contract benefits, changes in coverage, eligibility, claims, BCBSAZ programs, provider networks, etc.
Provider Claims Svcs Spec Blue Cross and Blue Shield AssociationProvider Claims Svcs SpecPhiladelphia, PAThis role acts as a liaison between providers and internal claims operations teams to ensure accurate, timely resolution and a high level of service in a fast-paced environment. The Provider Claims Service Specialist is responsible for responding to provider inquiries and resolving issues related to claims processing, reimbursement, and pricing.
Sales Operations Consultant Blue Cross and Blue Shield AssociationSales Operations ConsultantDes Moines, IAWhile prior experience in healthcare or sales operations is helpful, success in this role is rooted in transferable skills such as project execution, relationship building and management, and a passion for continuous improvement, change management, and operational excellence. You'll partner closely with Sales, Marketing, Sales Training, Market Solutions, and other key departments to execute go-to-market activities, support ongoing governance of sales systems and processes, and manage key sales business initiatives.
Corporate Security Officer Blue Cross and Blue Shield AssociationCorporate Security OfficerDes Moines, IAIn this position, you will lead security operations through conducting advanced patrols, actively monitoring security systems, and responding to incidents with a high degree of independence, judgment, and decisiveness. 5+ 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).
Customer Service Rep (Level Care) Blue Cross and Blue Shield AssociationCustomer Service Rep (Level Care)Philadelphia, PARemoteAll participants are expected to be physically present at our 1900 Market Street, Philadelphia office location for a total of Nine (9) days, distributed across Three (3) separate weeks during the 12-week training period. Advises the Supervisor when any of the above accountabilities cannot be performed because of matters beyond the control of the Representatives, such as system, procedural, or administrative errors that indicate a trend.
Customer Service Rep I - BCN (Detroit) C-S-R Blue Cross and Blue Shield AssociationCustomer Service Rep I - BCN (Detroit) C-S-RSouthfield, MIOne (1) year of related work experience in areas such as public/customer service, sales representative, claims processing, membership enrollment. Primarily conducts low complexity internal and external research to determine and request the data needed to handle inquiries regarding membership.
Customer Service Rep I - KLASC (Grand Rapids) C-S-R Blue Cross and Blue Shield AssociationCustomer Service Rep I - KLASC (Grand Rapids) C-S-RGrand Rapids, MIOne (1) year of related work experience in areas such as public/customer service, sales representative, claims processing, membership enrollment; or one (1) year of public contact in positions such as teaching, social service work, bank teller, medical assistant/office assistant. One (1) year of total related experience or in the absence of internal BCBSM experience, the following may apply: One (1) year of related work experience in areas such as public/customer service, sales representative or claims processing.
Provider Relations Representative - Louisiana Blue Cross and Blue Shield AssociationProvider Relations Representative - LouisianaBaton Rouge, LANecessary Contacts: In order to effectively fulfill this position, the incumbent must be in contact with: All levels of Plan management, EDI, Network Development, Network Operations, Provider Reimbursement, Marketing, Legal, and Benefits Administration; externally with Providers and office staff personnel. Pursuant 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.
Sr. Director, Pharmacy - Prior Authorization & Call Center Blue Cross and Blue Shield AssociationSr. Director, Pharmacy - Prior Authorization & Call CenterLong Beach, CARequires a Doctor of Pharmacy (PharmD) degree from an accredited school of pharmacy in the U.S. Requires 12 years of prior experience in: a managed care health plan or pharmacy benefit management companies or other relevant settings; pharmacy prior authorization program and call center operations; developing and implementing strategic operational plans to optimize efficiency and cost outcomes. Collaborate cross-functionally with BSC Medical Directors, Appeals and Grievance and care management teams to share accountability for evidence-based decision-making, promote adherence to BSC coverage policies, facilitate care coordination and optimize customer experience.
Sr. Director, Pharmacy - Prior Authorization & Call Center Blue Cross and Blue Shield AssociationSr. Director, Pharmacy - Prior Authorization & Call CenterOakland, CARequires a Doctor of Pharmacy (PharmD) degree from an accredited school of pharmacy in the U.S. Requires 12 years of prior experience in: a managed care health plan or pharmacy benefit management companies or other relevant settings; pharmacy prior authorization program and call center operations; developing and implementing strategic operational plans to optimize efficiency and cost outcomes. Collaborate cross-functionally with BSC Medical Directors, Appeals and Grievance and care management teams to share accountability for evidence-based decision-making, promote adherence to BSC coverage policies, facilitate care coordination and optimize customer experience.
Sr. Director, Pharmacy - Prior Authorization & Call Center Blue Cross and Blue Shield AssociationSr. Director, Pharmacy - Prior Authorization & Call CenterEl Dorado Hills, CARequires a Doctor of Pharmacy (PharmD) degree from an accredited school of pharmacy in the U.S. Requires 12 years of prior experience in: a managed care health plan or pharmacy benefit management companies or other relevant settings; pharmacy prior authorization program and call center operations; developing and implementing strategic operational plans to optimize efficiency and cost outcomes. Collaborate cross-functionally with BSC Medical Directors, Appeals and Grievance and care management teams to share accountability for evidence-based decision-making, promote adherence to BSC coverage policies, facilitate care coordination and optimize customer experience.
Sr. Director, Pharmacy - Prior Authorization & Call Center Blue Cross and Blue Shield AssociationSr. Director, Pharmacy - Prior Authorization & Call CenterSan Diego, CARequires a Doctor of Pharmacy (PharmD) degree from an accredited school of pharmacy in the U.S. Requires 12 years of prior experience in: a managed care health plan or pharmacy benefit management companies or other relevant settings; pharmacy prior authorization program and call center operations; developing and implementing strategic operational plans to optimize efficiency and cost outcomes. Collaborate cross-functionally with BSC Medical Directors, Appeals and Grievance and care management teams to share accountability for evidence-based decision-making, promote adherence to BSC coverage policies, facilitate care coordination and optimize customer experience.
Sr. Director, Pharmacy - Prior Authorization & Call Center Blue Cross and Blue Shield AssociationSr. Director, Pharmacy - Prior Authorization & Call CenterWoodland Hills, CARequires a Doctor of Pharmacy (PharmD) degree from an accredited school of pharmacy in the U.S. Requires 12 years of prior experience in: a managed care health plan or pharmacy benefit management companies or other relevant settings; pharmacy prior authorization program and call center operations; developing and implementing strategic operational plans to optimize efficiency and cost outcomes. Collaborate cross-functionally with BSC Medical Directors, Appeals and Grievance and care management teams to share accountability for evidence-based decision-making, promote adherence to BSC coverage policies, facilitate care coordination and optimize customer experience.
Sr. Director, Pharmacy - Prior Authorization & Call Center Blue Cross and Blue Shield AssociationSr. Director, Pharmacy - Prior Authorization & Call CenterRedding, CARequires a Doctor of Pharmacy (PharmD) degree from an accredited school of pharmacy in the U.S. Requires 12 years of prior experience in: a managed care health plan or pharmacy benefit management companies or other relevant settings; pharmacy prior authorization program and call center operations; developing and implementing strategic operational plans to optimize efficiency and cost outcomes. Collaborate cross-functionally with BSC Medical Directors, Appeals and Grievance and care management teams to share accountability for evidence-based decision-making, promote adherence to BSC coverage policies, facilitate care coordination and optimize customer experience.
Client Solutions Executive -National Sales Blue Cross and Blue Shield AssociationClient Solutions Executive -National SalesPhiladelphia, PAThe Client Solutions Executive is a key member of the National Sales team, responsible for driving strategic retention and growth across nationwide accounts and managing high-value client relationships. • Partner with internal teams (Underwriting, Product Development, Compliance, and Operations) to design tailored solutions that meet evolving client needs.
Customer Care Navigator, ABA services - remote (PA/NJ/DE) Blue Cross and Blue Shield AssociationCustomer Care Navigator, ABA services - remote (PA/NJ/DE)Philadelphia, PARemoteThe ACNs are responsible for serving as a single point of contact for families, ensuring accurate and viable referrals for diagnostic, ABA and other care, outreaching member families, screening for behavioral and medical care management needs, assessing for and providing community resources, educating members regarding benefits and authorization process, coordinating with Autism care managers to ensure support positive member experience, other responsibilities as assigned. Responsible for making outreach calls to member families to educate them around the Autism Case management program, screen for any care management or referrals, support program document collection, and coordinate with the care managers on member and family care needs, Collaborate with network providers to identify appropriate referrals for diagnostic, ABA and specialty care.
Sr. Director, Pharmacy - Prior Authorization & Call Center Blue Cross and Blue Shield AssociationSr. Director, Pharmacy - Prior Authorization & Call CenterRancho Cordova, CARequires a Doctor of Pharmacy (PharmD) degree from an accredited school of pharmacy in the U.S. Requires 12 years of prior experience in: a managed care health plan or pharmacy benefit management companies or other relevant settings; pharmacy prior authorization program and call center operations; developing and implementing strategic operational plans to optimize efficiency and cost outcomes. Collaborate cross-functionally with BSC Medical Directors, Appeals and Grievance and care management teams to share accountability for evidence-based decision-making, promote adherence to BSC coverage policies, facilitate care coordination and optimize customer experience.
Sr. Director, Pharmacy - Prior Authorization & Call Center Blue Cross and Blue Shield AssociationSr. Director, Pharmacy - Prior Authorization & Call CenterLodi, CARequires a Doctor of Pharmacy (PharmD) degree from an accredited school of pharmacy in the U.S. Requires 12 years of prior experience in: a managed care health plan or pharmacy benefit management companies or other relevant settings; pharmacy prior authorization program and call center operations; developing and implementing strategic operational plans to optimize efficiency and cost outcomes. Collaborate cross-functionally with BSC Medical Directors, Appeals and Grievance and care management teams to share accountability for evidence-based decision-making, promote adherence to BSC coverage policies, facilitate care coordination and optimize customer experience.
Commercial Sales Operations, Principal - Stellarus Blue Cross and Blue Shield AssociationCommercial Sales Operations, Principal - StellarusChicago, ILThis role partners closely with Sales Development, Sales Leadership, Marketing, Finance, and Product to design and maintain the infrastructure, processes, and analytical frameworks that enable predictable growth. Requires experience partnering cross‑functionally with Sales, Sales Development, Marketing, Finance, Legal, and Deal Desk teams to streamline deal cycles and improve operational efficiency.
Commercial Sales Operations, Principal - Stellarus Blue Cross and Blue Shield AssociationCommercial Sales Operations, Principal - StellarusDenver, COThis role partners closely with Sales Development, Sales Leadership, Marketing, Finance, and Product to design and maintain the infrastructure, processes, and analytical frameworks that enable predictable growth. Requires experience partnering cross‑functionally with Sales, Sales Development, Marketing, Finance, Legal, and Deal Desk teams to streamline deal cycles and improve operational efficiency.