Your Role The Actuarial Reserving team develops Incurred but Not Reported (IBNR) reserve models and reporting while considering the impacts of emerging operational and trend dynamics on reserve levels . The Actuarial Analyst, Experienced will report to the Senior Manager of Reserving. In this role you will collaborate with partners in Accounting, Operations, IT, and other

Your Role The Network Trend Analytics team is responsible for performing financial modeling and analytics for provider contract negotiations for hospitals and ambulatory surgery centers. The Associate Actuarial Analyst will report to the Senior Manager. In this role you will be applying your analytical toolset to project future unit cost trends and drive the development o

Your Role The Law Business team brings experience, expertise and solutions in technology, data management and other support services to help the Law Department continuously improve and excel in our support of BSC and its affiliates. The Business Analyst will be responsible for providing technical support to the Law Department teams and will report to the Law Business Team

Your Role This role resides within the IT Applications' Transformation, Operations & Customer Experience team. The candidate will report to the IT Director, Solution & Delivery Lead in the Portfolio. In this role you will be responsible for leading, facilitating, and driving continuous improvement of Agile practices for the team or teams that you'll be supporting. The Por

Your Role The Appeals and Grievances team receives, documents, investigates, refers, and coordinates grievances, appeals and complaints . The Appeals and Grievances Coordinator will report to the Appeals and Grievances Supervisor. In this role you will be responsible for taking incoming telephone calls, reviewing, researching, and responding to incoming appeals and grieva

Your Role The ACA Chart Program team conducts the following functions (1) identify medical records with unreported diagnosis codes, (2) retrieve those medical charts, (3) perform medical coding to convert them into risk adjustable diagnosis codes, and (4) submit to CMS via the EDGE pathway . The Risk Adjustment, Consultant will report to the Senior Manager . In this role

Your Role The Centers of Excellence (COE) Systems Analyst team defines and deliver solutions that meet business objectives and will serve as a facilitator between the business and IT in understanding the business needs; leads eliciting, analyzing, validating, and managing requirements, processes, and high level solution designs; is a proactive member of an Agile product t

Your Role The Delegation Oversight Utilization Management team is responsible for the organization, tracking and data entry of IPA Utilization Management audits, issues, complaints and monitoring. Identifies root cause of the problem and maintains monthly reporting that track and compare patters of delegated entities. The Delegation Operations Nurse Auditor LVN Experience

Your Role The Innovation Analyst, Consultant is responsible for supporting the improvement and maintenance of our integrated enterprise strategy to execution process and supporting initiatives designed to provide strategic thought leadership to business leaders across the enterprise to address ambiguous problems and opportunities. This role will serve as a change agent, l

Your Role The Workforce Management team partners with operations to ensure the contact centers are staffed appropriately to meet KPI's while looking for opportunities to gain efficiency. The Workforce Optimization Analyst will report to the Sr. Manager of WFM. In this role you will analyze contact center trends, including call volumes, offline inventory, and call patterns

Your Role The Care Management team will serve to support the mission of the department, which is to provide support to patients in maintaining health and wellness in the outpatient setting . The Senior Care Manager will report to the Manager of Care Management. In this role you will ensure that services are provided based on standardized procedures including coordination

Your Role The Reporting, Analysis and Administration team supports Blue Shield of California with design, development, and management of Verint, Genesys and Avaya platforms. We provide business support expertise and manage requirements deliverables. Currently, this includes Routing, Quality, Speech, WFM, Performance Management and Desktop Analytics modules. The Business A

Your Role The Managed Care Finance team administers the financial terms and conditions of our capitated contracts with IPA/Medical Groups, Hospitals, and Vendors. The Financial Analyst, Experienced will report to the Manager of Managed Care Finance. In this role you will be performing provider contract analysis, financial research, preparing financial forecasts, analyzing

Blue Shield of California's mission is to ensure all Californians have access to high quality health care at a sustainably affordable price. We are transforming health care in a way that truly serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience. To fulfill our mission, we must ensure a diverse, equitable, an

Your Role The Federal Employee Program (FEP) team performs integrated case management (CM) and disease management (DM) activities demonstrating clinical judgment and independent analysis, collaborating with members and those involved with members' care including clinical nurses and treating physicians . The Registered Nurse Case Manager will report to the FEP Department M