Your Role The Innovation Analyst, Principal is responsible for providing thought leadership to business leaders across the enterprise to address ambiguous problems and opportunities through internal strategy and/or innovation consulting engagements. This role will serve as a change agent, leveraging a consistent and disciplined approach to strategy and innovation to desig

Create communications through the eyes of healthcare provider organizations and practitioners developing positive and informative experiences and meaningful touch points Develop strategic, comprehensive communication plans that incorporate a full spectrum of tools and tactics (letters, digital content, etc.) Present and project manage implementation of comprehensive commu

Your Role The Installation and Billing (I&B) team within Blue Shield of California oversees the enrollment, billing and payments process for their groups and members. The Experienced Business Analyst will report to the Manager of Programs and Projects. In this role you will drive the facilitation, management and analysis of incidents related to enrollment, billing, and in

Your Role The Federal Employee Program (FEP) team performs integrated case management (CM) and disease management (DM) activities in collaboration with members and those involved with members' care including registered nurse case managers, social workers, dietitians, health coaches, pharmacists, and physicians. The FEP Health Coach will report to the FEP Department Manage

Your Role The Medical Director provides clinical leadership within the Office of the CMO for Blue Shield Promise Health Plan, which includes management of the physician processes in support of utilization management and transactional functions. These functions include performance of preservice, concurrent, retrospective utilization review, Appeals and Grievances, and retr

Your Role The Global Business Services (GBS) department is responsible for delivering strategic and category supplier sourcing, contracting and governance excellence at Blue Shield of California. The Senior Manager, Procurement Contracting role will report to the Director, Contracting. In this role you will be responsible for the management, prioritization and execution o

Your Role The Case Management team performs and case management (CM) activities demonstrating clinical judgment and independent analysis, collaborating with members and those involved with members care including clinical nurses and treating MDs. . The Case Management Nurse, Senior will report to the Manager, Care Management. In this role you will determine, develop and im

Our Customer Experience Teams receive incoming telephone calls from our members. Our Call Centers are open 7 days a week. If hired, you will be required to attend and complete a paid, mandatory training. Training will be held in a remote environment. Remote training requires secure, reliable internet connectivity. Any hybrid work or training requires both remote and on pr

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 The Medi Cal Program Support (MPS) team ensures sufficient and complete Medi Cal operational documentation by reviewing and supporting development of business process documentation; development of regulatory data and files process documentation; and development of employee trainings. The Business Analyst will report to the Senior Manager of the Business Process

Your Role The Special Investigations Unit team is responsible for preventing, detecting, investigating, and resolving health care fraud, waste, and abuse . The Special Investigations Investigator, Consultant will report to the SIU Manager. In this role you will represent a high level of professionalism both internally and externally. Conduct investigations in accordance w

Your Work In this role, you will Be responsible for analytic work required to convert pricing and financial goals at the line of business and region level into specific action plans at the provider level that the Network team can execute Build and update models that allow the actuarial team to quantify financial gaps and opportunities at a provider level Conduct and devel

Your Work In this role, you will Be responsible for converting pricing and financial goals at the line of business and region level into specific action plans at the provider level that the Network team can execute Create value for the Growth team General Managers by ensuring they have a voice when it comes to key network decisions and network strategy Create value for th

Your Role The Network Performance Analysis and Contracts is part of the Provider Partnerships & Network Management Division and focuses on provider network performance analysis, reporting, and consulting. The Data Analyst Health, Experienced will report to the Manager, Data Analysis. In this role you will provide analytical support through the analysis and interpretation

The Medicare team is responsible for servicing Medicare members including Med Supp). Total Duals / D SNP (Dual Special Need Plans. The Supervisor will report to the department Manager. In this role you will manage a team of front line representatives, focusing on coaching/engagement, Quality, Inventory Management and helping evolve member experience. Our leadership model