Blue Cross & Blue Shield jobs in San Diego, 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 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 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 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 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 This role supports Stellarus and related activities within the Ascendiun Family of Companies, as appropriate. The Integration and Interoperability Platform team delivers modular, reusable, and secure integration capabilities that accelerate product development, ensures interoperability across systems, and supports enterprise-wide data exchange. The platform enables self-service access to integration services, promotes standardization, and simplifies connectivity across internal and external applications. The Service Integration Summer Intern will report to the Service Integration Manager. In this role you will collaborate with senior engineers to design, develop, and deploy secure, scalable, and high-performing automation solutions that will facilitate and enable development teams with their API development activities. 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 Consultative Support and Project Management team provides analytical support in preparation of contract negotiations and manages competitive intelligence data for the organization. The Data Analyst, Senior will report to the Manager of Data Analysis. In this role you will work cross functionally with teams such as Actuary, Network Compliance, and Contracting Network Managers to develop an understanding of the overall health of contracted entities. You will identify trends, investigate anomalies, and communicate your findings. You will also own the creation and distribution of reports that are critical to the future planning and financial health of the organization.

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 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 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.

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 Information Resource Center (IRC) Manager is responsible for managing the Blue Shield Promise Health Plan Information Resource Center (IRC). The center connects members from both Blue Shield Promise and the San Diego community to resources and personalized services that foster community connections, address social needs, and keep people active, healthy and informed. The IRC Manager will report to the Senior Manager of Operations. In this role you will manage the IRC Representatives and Community Health Advocate (CHA) assigned to the IRC. You will provide leadership and oversight of the team's roles and responsibilities such as providing care coordination for Blue Shield Promise members, participating in community events, and offering access to care and support services during field visits and at the IRC. In addition, you will work collaboratively with other leaders to manage the day-to-day operations and management of the IRC. 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 Community Programs team provides high-touch engagement with members and community-based organizations to remove barriers to healthcare access, enhance population health initiatives and advance health equity. The Community Connector Health Advocate will report to the Community Programs Manager, Operations. In this role you will serve as the Blue Shield of California Promise Health Plan's community expert. You will be responsible for creating meaningful relationships with community-based organizations, participating in community events and acting as the health plan liaison. In addition, you will assist members with complex health and/or social needs by assessing their immediate needs and addressing barriers to care to include, but not limited to, care coordination, linkages to health plan services and community resources. This position requires frequent travel locally in San Diego County.

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 Audit Services team performs internal audits and advisory services to provide assurance on specific internal control objectives and emerging risk areas. The Internal Audit Principal will report to the Internal Audit Senior Director. In this role, you will be leading and managing financial, operational, and integrated audits and advisory engagements. You will also be assessing the design and effectiveness of internal controls for business processes, financial reporting and measurement activities, and related applications in accordance with laws, regulations, policies, standards, and procedures using established tools and techniques.

Your Role The Behavioral Health Operations Oversight team maintains program integrity and ensures compliance with regulatory and accreditation standards. The Program Manager, Principal, Behavioral Health Audits & Accreditation will report to the Senior Manager, Behavioral Health Audits & Accreditation. In this role you will support Blue Shield's Behavioral Health program through audit and accreditation readiness efforts to meet federal and state requirements.