Blue Cross & Blue Shield jobs in Palmdale, CA

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 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 Digital Compliance and Operations team ensures that our web and mobile sites are compliant with all state and federally mandated requirements and drives changes to our web and mobile sites to support these legal requirements. The Digital Product Manager, Consultant role will report to the Senior Program Manager, Digital Operations. In this role you will help define the short-term and long-term product roadmap. You will work with cross-functional teams in a fast paced, agile environment and will be responsible for managing product development deliverables such as requirements documentation, analytics, design reviews, implementation, and delivery. 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 Pharmacy Markets, Products, Analytics and Strategies (RxMAPS) team is responsible for leading and collaborating cross-functionally with key stakeholders across Pharmacy Strategy and Operations and Blue Shield. The RxMAPS team drives analytic strategy and performs clinical and business analyses necessary to provide consultations and strategic program recommendations to improve Cost of Health Care (COHC) and optimize outcomes. The Principal Pharmacist, Cost of Health Care will report to the Senior Manager, Rx Data Information Oversight and Reporting. In this role you will play a key role in leading and collaborating cross-functionally with key stakeholders across Blue Shield to drive analytic strategies and perform clinical and business analyses to improve COHC and optimize outcomes. You will monitor pharmacy and medical drug trends and the drug pipeline, and work with Actuarial and Finance teams to explain drivers of trend and identify opportunities for trend management. You will work with Enterprise Analytics to track and forecast COHC savings from pharmacy initiatives.

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 Delegation Oversight (DO) team, under the purview of the Delegation Oversight Committee (DOC) which is a sub-committee of the Quality Oversight Committee (QOC), is responsible for oversight of contracted delegated entities. This includes auditing, corrective actions follow-up and monitoring activities. The DO team will coordinate with other internal departments on oversight activities. Reporting to the Manager, Delegation Oversight, this role is responsible for documentation of policies and procedures, and oversight of LA Care audits and quality review along with submission of data to compliance. The Operations Specialist, Experienced, is also responsible for working with colleagues on coordination and submission of state reporting to the Department of Managed Health Care (DMHC). This position is responsible for tracking and monitoring monthly, quarterly, and annual reporting timeliness and Provider Dispute Resolution to provide into the DMHC portal reporting. The Operations Specialist, Experienced position also reviews and provides to the DMHC Corrective Action Plans (CAPs) and requests for information.

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 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 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 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.

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 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 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 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.

This role will align to the Quality team within the Care Management & Quality Platform that designs and solutions accountable for secure, compliant and high-quality software delivery. The Full Stack Engineer will report to the Senior Manager of the Quality Team. In this role, you will be deeply involved in the hands-on 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 will implement and help to ensure DevSecOps best practices tailored to 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 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 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.