Blue Cross & Blue Shield jobs in Rancho Cordova, CA - 229 jobs

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 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 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.

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.

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 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 Quality Review team completes audits of front-line staff to ensure alignment with department processes and regulatory compliance. Clinical Quality Auditors also provide coaching and work closely with business leaders to drive optimal results. The Clinical Quality Auditor, Consultant will report to the Quality Review Senior Manager. In this role you will develop performance metrics, evaluate performance, and provide coaching to ensure that staff have the skills and knowledge required to be successful in Population Health Management and Utilization Management.

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 Global Business Services team sources for all vendors and goods needed for Blue Shield of California and other entities under the Ascendiun holding company umbrella. This role oversees Stellarus procurement and sourcing for the Product division of Stellarus. The Director, Sourcing for Stellarus will report to the Sr. Director, IT Enterprise Sourcing. In this role, you will be responsible for contracting for new products for Stellarus to commercialize in the marketplace and contracting with potential health plan customers. This role is also to develop this contracting and sourcing muscle, as we build our product strategy. Working closely with the VP, Product and Chief Technology Officer, this role will be responsible for supporting the commercialization contracting. As new partnerships and health plan customers come on board, this role will be responsible for the sourcing, contract and procurement needs.

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 As a Clinical Coding Analyst-Experienced, specializing in code governance, you will play a pivotal role in ensuring coding standards, compliance, and best practices across development teams. Your responsibilities will include implementing and maintaining a code governance framework, conducting code reviews, optimizing development workflows, and ensuring adherence to industry standards. You will collaborate with cross-functional teams to establish coding guidelines, automate governance processes, and enhance overall software quality and security. Your expertise will drive efficiency, consistency, and compliance in coding practices, supporting scalable and maintainable solutions.

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 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 development for workflow automation, robotic process automation, and application integration. 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.

Your Role The Product Manager, Consultant - Digital Experience will drive improvements in digital satisfaction, MSAT, and Digital NPS by leveraging advanced analytics and observability tools to proactively identify and resolve user experience issues. Integrating survey and monitoring data, this role aims to reduce friction, improve site health/service availability, and deliver measurable customer experience gains. Own the backlog and outcomes for digital observability and experience analytics - integrate Dynatrace Real User data and digital survey data to reduce friction, cut MTTD/MTTR, and lift Digital Satisfaction, MSAT, and NPS.

Your Role The Finance, Cost of Health Care (CoHC) team is responsible for financial oversight, analytics and strategic planning to manage and reduce healthcare costs across all lines of business for Blue Shield of California. The Data Analyst - Behavioral Health, Principal will report to the Medical Informatics Analyst - Sr Principal. In this role you will be collaborating with leadership in developing behavioral health finance analytics including measurement of the internal cost of healthcare, and reporting and analytics supporting the various stakeholders in the behavioral health (BH) insourcing project. A key responsibility will be to work with Line of Business Leadership on their cost of health care metrics and analytics.

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 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 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.