Blue Cross & Blue Shield jobs in Long Beach, CA - 103 jobs

Your Role The AI and Analytics team oversees the artificial intelligence platform and analytical functions. In this role, you will be providing critical analytics support to our healthcare insurance clients (BlueShield of California and other health plans). This role is responsible for driving data-informed strategies and delivering actionable insights to optimize marketing campaigns and improve business outcomes. The ideal candidate is a strategic thinker with a strong analytical mindset and a passion for using data to solve complex Marketing business problems. They would be leading projects end-to-end, independently presenting insights to senior leadership, and mentoring junior analysts.

The Payer Systems Applications team plays a critical role in enhancing customer and technical collaboration while delivering all application development through a Platform and Technology Product Operation Model. The candidate will report to the Sr. IT Manager, Application Services Lead. 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 Portfolio is responsible for the development and support of complex technology solutions from claims processing to benefit enrollment. The Agile team that this role will lead has representation from across our matrixed organization, including IT, business & vendor partners, to deliver value & capabilities that meet the needs of our customers. We strive to deliver sustainable solutions that optimize cost, quality, and fit for purpose. This role specifically is planned to support Agile delivery related to our Member Customer Experience area as part of our Membership and Support Platform.

Your Role The Compliance and Ethics team ensures adherence to the BSC Code of Conduct and owns and coordinates the Company's compliance and ethics program across the enterprise, including all business units, products, services and activities. This includes the implementation and maintenance of proper preventive, detective and remedial programs and controls; the execution of relevant policies and procedures; training and educating the workforce; implementing an effective communications program; ensuring effective testing, auditing, monitoring, tracking and reporting; and remediate control deficiencies. This Senior Level Compliance and Ethics Specialist is a critical individual contributor and program lead who will report to the Senior Manager, Compliance and Ethics. In this role you will work closely with the Senior Manager and department to drive and lead the department's strategic priorities and projects, including advancing the compliance training program, developing and implementing compliance policies such as the Conflict of Interest, Gifts and Entertainment, Anti-Corruption, etc., and serve as a subject matter expert on compliance issues, providing guidance and support to various departments within the organization. Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow - personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.

Your Role The Stellarus Product and UX team defines and designs technology products, creating solutions for users across the spectrum of healthcare. The Product Designer, Consultant will report to the Director of UX Research & Product Design. In this role you will work with internal stakeholders and team members to design digital product solutions that solve and support our user's needs, expectations, and pain points. Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow - personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.

Your Role The Risk Adjustment Retrospective Analytics team focuses on delivering complete and accurate analytics for Prospective and Retrospective suspecting, financial impact calculations, and data submission. The Risk Adjustment Analyst, Experienced will report to the Manager of Risk Adjustment Analytics. In this role you will develop and refine Risk Adjustment Suspecting logic, quantify the financial impact of the Risk Adjustment programs, and support complete and accurate data submission for both Medicare Advantage and ACA Chart Review Programs.

Your Role The Platforms team is focused on optimizing solutions and maximizing value across the enterprise through our strategic platforms, Pega and Salesforce. We are a team of Product Managers, Business Analysts, Platform System Administrators, and strategic shared services who build and maintain technology solutions that run critical business operations including Marketing, Sales, Customer Experience, Care Management, and Operations. Our team drives vendor relationships, product strategy, solution design, and backlog execution in collaboration with IT and business stakeholders. The Platforms team intern will report to the Program Manager Shared Services and Sr. Manager Shared Services. In this role you will learn how to solve business needs through technology and gain key skills to prepare you for your career. Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow - personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.

Your Role The Drug Utilization Review & Prior Auth team processes and reviews prior authorization requests from the MD's office. The Pharmacy Technician, Intermediate will report to the Supervisor, Pharmacy Services Operations. In this role, you will work independently to review medication cases while adhering to insurance company guidelines and regulations. Responding to and resolving prior authorization inquiries through real-time communication channels and ensuring seamless communication within the team.

Your Role The Advanced Analytics team works in partnership across the entire Blue Shield of CA enterprise to accelerate business outcomes through the application of AI/machine learning, statistical methodologies, or unstructured data analysis techniques to uncover insights, predict behaviors, and ultimately drive automation to create "intelligence at scale". The Data Scientist, Consultant will report to the Director, Advanced Analytics. In this role you will solve problems which range from but are not limited to, text analytics of customer feedback, conversations, and clinical notes, predicting clinical disease progression, understanding the impact of population health programs, clustering member behaviors, creating propensity models, and geospatial analysis of populations to uncover social determinants of health.

Your Role The Law Department Intern will work with the attorneys in the Law (Corporate Law, Litigation, Health Law, Privacy, and Compliance) and Government Affairs teams to support clients across the Company. Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow - personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.

Your Role The Promise Medi-Cal Compliance team oversees and coordinates Blue Shield Promise Health Plan's (BSCPHP) compliance program. The Government Programs Compliance Analyst, Consultant will report to the Senior Director, Government Programs Compliance. In this role you will provide assistance with driving and managing the identification and scoping of impacts across cross-functional business areas due to ongoing, newly enacted, or federal and state regulatory requirements.

Your Role Reporting to the VP, Network Operations, the Director, Provider Services - Relations, Blue Shield of California and Promise Health Plan (BSCPHP), is responsible for creating and maintaining high integrity relationships with risk-baring medical providers, hospitals and health systems in their assigned region to enable BSCPHP to become the health plan of choice. The outcome of being the ideal partner for our providers will be to materially improve cost, quality, maintain compliance, service and together grow membership in service to our communities across BSCPHP business. The Director will lead in a highly matrixed environment across multiple internal business teams to provide strategic alignment, business planning, and effective execution of the business plans for all providers in their region for BSCPHP business as well as partner with all lines of business as they impact our Provider Network. Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow - personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.

Your Role The Care Management team coordinates, educates, and advocates care for the Dual-Special Needs (DSNP) population with Blue Shield of California. The Case Management - Nurse, Senior will report to the Manager of Care Management within Medical Care Solutions. In this role you will be responsible for managing a caseload of DSNP members, reviewing Health Risk Assessments and completing Individualized Care Plans, engaging members to reduce readmissions to the hospital, and supporting the DSNP care management team. Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow - personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.

The Application Services team plays a critical role in enhancing customer and technical collaboration while delivering all application development through a Platform and Technology Product Operation Model. The DevOps Analyst will report to the IT Applications Director. In this role you will be the comprehensive subject matter expert in the technology products/platform feature space and apply, learn, and extend your skills beyond formal role boundaries. Having a desire to help achieve transformational healthcare improvement should serve as the inspiration behind the ideal candidate's willingness to participate across many different activities within an agile working model. Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow - personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.

Your Role The Clinical Program Manager, Principal in collaboration with the Regional Medical Director and the CMO Team for Commercial Business will be responsible for collaborating with all internal stakeholders and externally facing partners to transform the way health care is delivered, ensuring best-in-class care for all members. Priority is given to delivering on the Quadruple Aim (lower cost care, increased quality, increased member satisfaction and physician satisfaction) with a focus on execution to drive and accelerate improvements in primary care for all patients. This role will report to the Regional Medical Director.

Your Role The Internal Auditor Consultant will report to the Internal Audit Senior Director. In this role you will be responsible for providing objective examinations of evidence for providing independent assessment to the Audit Committee, management and outside parties on the adequacy and effectiveness of governance, risk, management and control processes.

Your Role The Application Services team plays a critical role in enhancing customer satisfaction and technical collaboration while delivering all application development through a Platform and Technology Product Operating Model. The Full Stack Engineer role will report to the Director, IT Applications (Integration and Interoperability Platform). In this role you will be deeply involved in the design, development, and deployment of secure, high-quality software solutions. Your role will focus on integrating security and automation throughout the software development lifecycle (SDLC), with an emphasis on writing clean, maintainable code and building infrastructure that supports CI/CD pipelines, automated testing, and cloud-native delivery. You'll implement and enforce DevSecOps best practices tailored for Azure, contribute to infrastructure as code, and work closely with developers, testers, and cloud engineers to ensure code is secure, scalable, and production-ready from day one. This role requires a hands-on engineer who thrives in a collaborative environment and is passionate about code quality, automation, and secure cloud development. Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow - personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.

Your Role The Quality Improvement Team is accountable for quality ratings and the organization, development, and execution of targeted, quality improvement initiatives in support of commercial medical groups, hospitals, affiliated providers, and our Covered California and CalPERS membership. The Program Manager, Senior will report to the Senior Manager, Quality Improvement. In this role you will be responsible in the commercial line of business for the development and execution of targeted, quality improvement initiatives with our external provider group partners to achieve improved outcomes in HEDIS measures. You will partner with other lines of business and align quality interventions to the organizational strategies for HEDIS, QRS, CAHPS, and our Covered California and CalPERS membership. The Program Manager, Senior will build relationships internally and externally, and manage data driven outcomes and targets, helping to facilitate getting provider data into our Blue Shield systems.

Your Role The Internal Controls Advisory Services team provides objective consulting and advisory services designed to add value and assist management with establishing and maintaining an effective system of internal controls. The team helps Blue Shield of California accomplish its objectives by implementing a systematic, disciplined approach to the evaluation and improvement of risk management and control processes. The Internal Controls Consulting, Consultant will report to the Senior Manager, Internal Controls Advisory Services. In this role you will be you will collaborate to strengthen the effectiveness of the organization's controls, drive substantial improvements in overall performance and position our organization for continued growth and success.

Your Role The Application Services team plays a critical role in enhancing customer and technical collaboration while delivering all application development through a Platform and Technology Product Operation Model. The Manager, IT Development role will report to the Director, IT Development (Integration and Interoperability Platform). In this role you will ensure the successful delivery of platform engineering that will enable API management, message-oriented middleware, managed file transfer, FHIR integration, and event streaming. You will coordinate technical scope, timelines, and team velocity as well as lead efforts to modernize release management practices, accelerating the use of automation and AI to improve delivery speed, reliability, and scalability. This role is ideal for a strategic and hands-on leader who thrives in a fast-paced, cross-functional environment and is passionate about building high-performing teams and enabling enterprise integration. Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow - personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.