Prime Therapeutics jobs - 167 jobs

At Prime Therapeutics (Prime), we are a different kind of PBM, with a purpose beyond profits and a unique ability to connect care for those we serve. Looking for a purpose-driven career? Come build the future of pharmacy with us. Job Posting TitleProvider Relations Manager - RemoteJob Description The Manager of Provider Relations plays a critical leadership role in developing, managing, and maintaining strong internal and external relationships. The role is responsible for overseeing pharmacy outreach, independent pharmacy contracting, compliance and issue resolution with pharmacies to ensure network integrity, service quality, and cost-effectiveness. The role is also responsible for leading and managing a Provider Relations team to ensure effective performance management of employees, departmental interaction, and process improvements. Responsibilities Manage and mentor a team to achieve team and company goals, monitor performance and provide coaching and development opportunities Manage team through independent pharmacy contract processes for retail networks; serve as the primary point of contact for key pharmacy providers, including pharmacy outreach and strategic partners to ensure quality outcomes; includes oversight where pharmacy termination from pharmacy networks may occur Oversee and approve new key processes the team develops as part of continuous improvement and develop strategies to achieve world class status in operational effectiveness and pharmacy and client experience while ensuring compliance and adherence to all regulatory guidelines Serve as liaison between Prime and pharmacies by supporting legal correspondence, addressing escalated provider concerns and disputes, and strengthening the interface between contact center operations and provider relations through effective pharmacy communications Develop and maintain relationships with internal and external stakeholders regarding the management and development of Network Management strategies; actively oversee and support Peak Season activities, including pharmacy outreach and pharmacy communications Other duties as assigned Minimum Qualifications Bachelor's degree in healthcare, business or related area of study, or equivalent combination of education and/or relevant work experience; HS diploma or GED is required 6 years of work experience in customer service or contracting experience within healthcare, PBM or highly regulated industry 2 years of leadership/people management experience Must be eligible to work in the United States without the need for work visa or residency sponsorship Additional Qualifications Ability to learn complex IT systems, both internal and web based and be able to train others to use systems and maintain best practices and quick reference guides Above average knowledge of Microsoft Office Suite of products, including Excel and PowerPoint Demonstrated business written and oral communication skills Demonstrated ability to establish and rapport and build relationships at all levels within an organization Strong attention to detail, follow through and root cause analysis of issues Excellent organizational, time management, problem solving and analytical skills Preferred Qualifications Previous experience in pharmacy network management, legal or compliance Previous project management skills Previous experience with RxClaim Previous call center experience Certified Pharmacy Technician (CPhT) Previous work experience in the PBM or Healthcare Industry Previous experience leading a team in a call center environment Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their job, and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures Every employee must be able to perform the essential functions of the job and, if requested, reasonable accommodations will be made to enable employees with disabilities to perform the essential functions, absent undue hardship. In addition, Prime retains the right to change or assign other duties to this job. Potential pay for this position ranges from $81,000.00 - $138,000.00 based on experience and skills.To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page and click on the "Benefits at a glance" button for more detail. Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sex (including pregnancy), national origin, disability, age, veteran status, or any other legally protected class under federal, state, or local law. We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law. Prime Therapeutics LLC is a Tobacco-Free Workplace employer. Positions will be posted for a minimum of five consecutive workdays.

Job Description World Insurance Associates (“World”) is a unique financial services organization with a global network of brokers and specialists who empower people to make informed decisions to improve their risk management outcomes, modernize their benefits programs, and help them achieve their long-term financial goals. Founded in 2011, World is one of the fastest-growing, Top 25 insurance brokers in the U.S. with nearly 3,000 employees in more than 300 offices across North America and the U.K. World specializes in personal and commercial insurance, surety and fidelity bonding, employee and executive benefits, investment advisory and retirement plan services, and payroll & HR solutions. Insurance Sales Producer - Commercial Lines Client Advisor Position Overview World's Client Advisors bring risk management solutions to businesses and individuals. Your primary focus is identifying, prospecting, cultivating, and closing new commercial clients (small, medium, large) leveraging World's unique niche. While your focus is selling commercial lines risk solutions, you also are empowered to help clients with personal lines insurance, employee benefits, 401(k) and related retirement solutions, and payroll and human resources outsourcing solutions. World's investments in a broad range of solutions means you can prospect any company of any size to provide value to your client. Imagine the potential. Primary Responsibilities Identify, prospect, and cultivate new business, with a focus on commercial accounts Engage in all sales and marketing tactics (with extensive corporate marketing support) to move prospects through your funnel to closing Track all sales activities in HubSpot and leverage HubSpot to its fullest potential Utilize World's broad platform to bring risk management solutions to individuals and business owners. At World, you will have access to resources to help any client solve any challenge, including traditional commercial lines insurance, high net worth / private client, employee benefits, human capital and payroll outsourcing, and retirement financial services. Qualifications Must have proven experience with a range of insurance solutions to bring value to clients Must be willing to become each client's trusted risk management advisor and bring the entire World platform to each client (P&C, Employee Benefits, Retirement Plans, Wholesale, and Payroll and Human Resources outsourcing services) Must maintain all relevant insurance licenses from the first day of employment to be positioned to manage an existing book of business It is meaningful, but not mandatory, if you have: Sold commercial insurance for a top broker. Based on your experience, World will enhance your expertise through the company's training program; Used an insurance agency management software platform, like AMS360 and Epic, and have experience with a sales CRM (World uses HubSpot); and Built and presented client “pitch decks” / presentations. Compensation As a World Insurance Client Advisor, your compensation is tied to your effort and your performance. We offer a base salary plus commissions as well as a full suite of employee benefits, including a 401(k) match that is immediately fully vested. The base salary range for this role is $60,000 to $200,000+. The base salary depends on your experience and your ability to drive revenue. Your base salary grows as your book of business grows, with tremendous potential to significantly exceed the top of this range. Equal Employment Workforce and Workplace World celebrates and supports differences amongst its employees. World knows employing a team rich in diverse thoughts, experiences, and opinions allows World's employees and World's work environments to flourish. World is honored to be an equal opportunity workplace, dedicated to equal employment opportunities regardless of race, color, ancestry, religion, sex, national orientation, age, citizenship, marital status, disability, gender identity, sexual orientation, or Veteran status. In addition, World makes reasonable accommodations to known physical or mental limitations of an otherwise qualified applicant or employee with a disability, unless the accommodation would impose an undue hardship on the operation of World's business. TO EXECUTIVE SEARCH FIRMS AND STAFFING AGENCIES: World does not accept unsolicited resumes from any agencies that have not signed a mutual service agreement. All unsolicited resumes will be considered World's property, and World will not be obligated to pay a referral fee. This includes resumes submitted directly to Hiring Managers without contacting World's Talent team. #LI-GK1 Powered by JazzHR psc73mTqpM

The Manager, Client Services serves a critical role in the client service delivery model for our Major Accounts market segment. In this role you will drive higher group financial value and service-level satisfaction by serving as a client-facing lead ensuring seamless quote-to-card process by engaging in sales and retention meetings, owning key elements of client delivery and ensuring overall client satisfaction. Key elements of this role include collaboration with key internal and external stakeholders to articulate the vision for group service and product delivery and refine and execute on the enterprise roadmap for achieving that vision. Additionally, you will oversee all client needs, that includes management of RFP/RFI, implementation, reporting, renewal activities, issue resolution, product delivery and inquiries from internal Blue Cross NC teams, group administrators and consultant partners. What You'll Do Manage, mentor and lead a team of Client Delivery Experts (CDE's) and Client Advocacy & Resolution Experts (CARE) for overall client service delivery in conjunction with other key account management functions. Additionally, you will manage a Sales Delivery Expert (SDE) that is responsible for working with our New Business Consultant on RFP related activities to provide support in the end-to-end sales process. Ensure client inquiries are being resolved by CARE team timely and assist in managing escalated issues - includes all aspects of issue remediation as well as resolution of any underlying systemic issues / identification for process improvement opportunities. Manage key aspects of the client engagement delivery model including client advocacy, product / program education, communication, wellness, group reporting and worksite promotions. Attend client meetings as a senior service delivery member to promote and maintain strong relationships and ensure delivery of engagement protocols. Collaborate with external clients, producers/consultants in conjunction with the sales team in effectively communicating Blue Cross NC's strategic support model and the role of the team in executing this important business function. Monitor, engage and solicit feedback from consultant and clients to understand group needs to provide a best-in-class service experience on an ongoing basis. Create client implementation and enrollment roadmap, tracking Sales, Group CoE and Operations against roadmap to ensure fulfillment and client readiness by effective date. Monitor, track, trend and report goal attainment results to leadership. Collaborate with internal business owners to identify and share best practices and communicate key client experiences to seek process and sales resource improvement opportunities. Foster team culture of collaboration and accountability to meet best-in-class group service delivery, implementation and enrollment needs. Oversee custom data reporting in an effort to analyze group specific trends to support the business intelligence needs of the sales team to support external stakeholders Lead team responsible for the strategic development with internal matrix partners on competitive and winning new business proposals. Key contact for open enrollment support / market activities. What You Bring Bachelor's degree or advanced degree (where required) 8+ years of experience in related field In lieu of degree, 10+ years of experience in related field Must be able to obtain a North Carolina Health and Life Insurance license within the 60 days of employment in this position. Must possess and maintain a valid driver's license. Bonus Points Solid healthcare industry experience Proven background in claims processing and customer service excellence. Hands-on experience in proposal management, including development and delivery. Demonstrated business acumen for retention strategies and driving sales growth initiatives. Ability to collaborate effectively across teams and manage multiple priorities in a fast-paced environment. Salary Range At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs. Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs. *Based on annual corporate goal achievement and individual performance. $89,174.00 - $142,679.00 Skills

Objective, Typical Duties and Responsibilities We're currently seeking a Compliance Specialist to support the firm's Compliance Program. You will report to Manager-Compliance Operations Develop and manage a Compliance Department activity reporting system. Represent the compliance department in resolving issues involving new accounts set up with Operations and Accounting departments. Monitor general department email inboxes and/or department ticketing system reports to assure timely response or escalation if necessary to inquiries and information received. Provide support, education, and guidance to Financial Representatives and their staff as it relates to business processes, firm policies and procedures, industry rules, and other general inquiries. Assist management and other compliance personnel with the completion of various projects and testing. Other duties as assigned. Position Requirements Bachelor's degree (B.A./B.S.) in a related discipline required. Minimum two (2) years of Compliance and/or regulatory experience within both RIA and broker-dealer business segments., Series 7, 24 (or 26), 63, 65 (or 66), Series 53 (or 51), and Life, Health, & Variable Annuity Insurance Licenses (or the ability to obtain within 120 days of hire). Strong working knowledge of both brokerage and investment advisory business concerning the regulatory framework in which they operate. A deep understanding of industry rules governing supervision, suitability, and registrations. Excellent technology and communication skills Ability to work independently to manage time and prioritize tasks efficiently. Be a motivated self-starter who can make thoughtful, deliberate decisions with minimal assistance. The desire to be an enthusiastic, cooperative team player who is always seeking ways to improve processes. Preference Given to Candidates with the Following Qualifications: Have previous experience with and a thorough understanding of regulatory requirements under Reg-BI and PTE 2020-02. Already hold a Life, Health, & Variable Annuity license. Compensation The salary for this position generally ranges between $75,000-90,000. This range is an estimate, based on candidate qualifications and operational needs. The firm also has a bonus program. Perks & Benefits 401(k) with Employer Match Health Insurance (with HSA option) Dental Insurance Perks & Benefits (continued) Vision Insurance Life Insurance Flexible Paid Time Off Policy Flexible Spending Account (FSA) Healthy Work/Life Balance Maternity/Paternity Leave Policy Remote Work Opportunity About World Investment Advisors As part of World Insurance Associates, LLC World Investment Advisors is a nationally recognized financial services firm dedicated to providing the industry's premier wealth management and retirement plan investment advisory services to individuals, high net worth families and employers. Stimulating Environment At World Investment Advisors, we strive to provide a challenging, stimulating environment for the best and brightest in the industry. We believe our employees can best serve our clients and advisors in an atmosphere where individuals are treated fairly, where professional growth is fostered and encouraged, and where a healthy balance between work and home life is respected and preserved. We promote a friendly and collaborative work environment. We are motivated by team camaraderie and are obsessed with doing the right thing for our plan sponsor clients and their plan participants. Team-Oriented Professionals typically work together in teams with multiple people from different departments to meet our clients' needs. Our junior staff works with their team members to develop the skills and knowledge to succeed and assume more senior level positions as they progress at our firm. We welcome team members from different backgrounds with different perspectives to help us innovate and make a difference for our customers and our communities. Why World? Great company culture with an awesome team-oriented atmosphere! Mentorship Opportunities Ability to serve on different internal steering committees (Charitable Giving, DEI, Social, etc.) Professional growth opportunities Friendly and collaborative work environment Employee perks including fun team building opportunities, yoga/wellness, charitable giving/volunteering World Investment Advisors is an equal opportunity employer. We believe the most effective way to attract, develop and retain a diverse workforce is to build an enduring culture of inclusion and belonging. World is committed to equality and deeply believes in diversity in sexual orientation, gender, race, religion, ethnicity and other qualities that makes us all different. To Executive Search Firms and Staffing Agencies: World does not accept unsolicited resumes from any agencies that have not signed a mutual service agreement. All unsolicited resumes will be considered World's property, and World will not be obligated to pay a referral fee. This includes resumes submitted directly to Hiring Managers without contacting World's Human Resources Talent Department. #LI-GP1 #LI-REMOTE

As Director, Provider Service, you will play a key role in shaping and advancing the strategic vision for provider customer service. This leadership position empowers you to guide team leaders, drive support initiatives that meet high contractual and service standards and nurture a dynamic culture of excellence. You'll have the opportunity to analyze financial and service results, implementing meaningful strategies that enhance performance and deliver real value to the organization. What You'll Do Develop the strategic vision and key processes for the provider contact center, prioritizing support delivered through vendors, plan-to-plan, and PSA contact channels by business impact Partner with Operational leads and workforce management to supplement strategy with the development of budgets, staffing models, and operational performance standards Direct and improve Strategic Provider Services offering, maintaining close relationships with key (Platinum) providers including use of site visits to inform provider service strategy and resolve escalated claims and service issues Oversee support of non-platinum providers through virtual contact centers while providing oversight for vendor relations. Ensure plan-to-plan contacts are handled in line with BCBSA standards and service level expectations Communicating with managers and team leads on the provider service strategy and align on operational changes necessary for execution Resolve complex escalations and contribute to training development to maintain and improve service delivery Monitor and review service performance ensuring that provider service agreements are met Report operational updates to the Claims AVP and Operations VP; serve as a subject matter expert for provider service End to end inventory management to align with all regulatory, Internal, external and other applicable processing guidelines and timeliness expectations; includes evaluating and adjusting all processing guidelines as required to meet customer expectations. What You Bring Bachelor's degree or advanced degree (where required) 10+ years' experience in Health Care Delivery and Operations In lieu of degree, 12+ years of experience in related field. Deep health plan claims and service expertise. 5+ years of progressive leadership experience. Bonus Points Strong analytical skills with the ability to drive transformational, consumer centric change while managing operations - highly preferred Six Sigma/Continuous improvement experience - highly preferred What You'll Get The opportunity to work at the cutting edge of health care delivery with a team that's deeply invested in the community. Work-life balance, flexibility, and the autonomy to do great work. Medical, dental, and vision coverage along with numerous health and wellness programs. Parental leave and support plus adoption and surrogacy assistance. Career development programs and tuition reimbursement for continued education. 401k match including an annual company contribution Salary Range At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs. Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs. *Based on annual corporate goal achievement and individual performance. $143,616.00 - $229,786.00 Skills

The Configuration Manager supports the delivery of IT services by ensuring the Configuration Management Database (CMDB) remains accurate, current, and reliable. Operating within the ITIL framework and reporting into the ITIL Service Operations organization at Blue Cross, this role is responsible for managing the lifecycle of all Configuration Items (CIs), including their attributes and relationships. The Configuration Manager owns the Configuration Management System (CMS) and its integrations with discovery tools and other ITSM applications, ensuring that configuration management processes are clearly defined, consistently executed, and aligned with ITIL standards to maintain a high-quality, up-to-date CMDB. What You'll Do Own and manage the Configuration Management System (CMS), including the ServiceNow CMDB and ITOM modules (Discovery, Service Mapping, Event Management). Lead CMDB upgrades, migrations, and lifecycle management to maintain platform stability and data integrity. Serve as the key liaison between IT service teams, ServiceNow platform teams, and business owners to align configuration data with business processes and service definitions. Build and maintain strong relationships with ServiceNow module owners to ensure configuration data supports desired business outcomes. Translate complex CMDB and ITOM concepts into clear, business‑focused language for non‑technical stakeholders. Define, govern, and enforce ITIL Configuration Management processes to ensure an accurate, trusted CMDB. Design and maintain CMDB architecture, including discovery patterns, data models, CI relationships, service mapping, and access controls. Integrate patching and vulnerability data (e.g., cloud patching, Tenable) across cloud, infrastructure, and containerized environments. Evolve CMDB and discovery capabilities to support modern platforms such as AWS, Kubernetes, and OpenShift. Monitor and validate CMDB accuracy, discovery results, performance, and capacity; drive remediation of inconsistencies. Ensure all authorized Change, Release, Discovery, and Cloud activities are accurately reflected in the CMDB. Provide reporting, audits, and continuous improvement recommendations while operating effectively in a matrixed, shared‑ownership environment. What You Bring Experience working in a ServiceNow CMDB environment Understanding of service mapping concepts and business service relationships Understanding of cloud platforms (AWS) and knowledge of container technologies (Kubernetes or OpenShift) Bachelor's degree or advanced degree 5+ years of experience in related field In lieu of degree, 7+ years of experience in related field Bonus Points Familiarity with ITIL or ITSM frameworks certifications ServiceNow and/or ITIL certifications What You'll Get The opportunity to work at the cutting edge of health care delivery with a team that's deeply invested in the community Work-life balance, flexibility, and the autonomy to do great work Medical, dental, and vision coverage along with numerous health and wellness programs Parental leave and support plus adoption and surrogacy assistance Career development programs and tuition reimbursement for continued education 401k match including an annual company contribution Learn more Salary Range At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs. Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs. *Based on annual corporate goal achievement and individual performance. $107,901.00 - $172,642.00 Skills

The Manager, Medicare Claims, oversees end-to-end claims services for provider segments, meeting business goals. This role sets performance targets, manages claims processing and financials, handles submissions, refunds, and recoveries, and ensures claims accounting and reporting. Collaboration with claims leadership ensures alignment with customer needs and contracts. What You'll Do Streamline shared processing to reduce management by exception Set operational process to address market trends, BCBSNC capabilities and customer demand Manage accounting and financial reporting functions in support of the Finance Division including overseeing the gathering, preparation, analysis, and reconciliation of financial data to ensure compliance with accepted accounting principles and standards. Participate in projects to improve and/or facilitate claims processing, recovery, and accounting functions. Manage financial recovery activities including refunds and collections Manage team leads and staff by efficiently driving work volume to keep high level of utilization and engagement in the group Resolve complex claims appeal by coordinating with different stakeholders for certain high value claims Collaborate with Audit and Payment Integrity to sustain a pre-determined level of accuracy and quality Design and develop tools and techniques for improvements. Identifies needed process and procedural changes which will result in improved customer satisfaction. Serve as Medicare Claims Subject Matter Expert and single point of contact for performance monitoring and troubleshooting. Represent Claims Operations on monthly CMS calls with CMS Account manager answering questions, providing status updates and expertise routinely and on demand. Ability to engage as requested by Compliance with regulatory entities, especially CMS on monthly calls and serve as an internal point of contact to prepare feedback on issues under CMS review. Use good judgement in understanding issues and work with compliance to prepare for discussions. Ability to represent claims as a knowledgeable SME. What You Bring Bachelor's degree or advanced degree (where required) 8+ years of experience in related field. In lieu of degree, 10+ years of experience in related field. Bonus Points 1-2 years of Medicare and Medicaid experience or a highly regulated operational environment - highly preferred Strong analytical skills with the ability to drive change and manage operations Ensure risks associated with business activities are effectively identified, measured, monitored and controlled within accordance with compliance policies and procedures What You'll Get The opportunity to work at the cutting edge of health care delivery with a team that's deeply invested in the community. Work-life balance, flexibility, and the autonomy to do great work. Medical, dental, and vision coverage along with numerous health and wellness programs. Parental leave and support plus adoption and surrogacy assistance. Career development programs and tuition reimbursement for continued education. 401k match including an annual company contribution Salary Range At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs. Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs. *Based on annual corporate goal achievement and individual performance. $98,092.00 - $156,947.00 Skills Accounts Receivable (AR), Claims Analysis, Claims Management, Claims Processing, Claims Resolution, Claims Submission, Documentations, Financial Processing, Health Insurance, Insurance Claim Handling, Insurance Claims Processing, Insurance Industry, Medicare Advantage, People Management, Recruiting

Looking for a way to make an impact and help people? Join PacificSource and help our members access quality, affordable care! PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, sex, sexual orientation, gender identity, national origin, genetic information or age. PacificSource values the diversity of our community, including those we hire and serve. We are committed to creating and fostering a work environment in which individual differences and diversity are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths. Accountable for the effective management of appeals clinical staff. Responsible for hiring, training, coaching, counseling, and evaluating team member performance. May be called upon to perform routine day-to-day program functions. Actively participate in program development and implementation. Supervise and provide guidance to direct reports and other department staff regarding company policies, procedures, and operations. Manage the quality and productivity of team tasks and workflow as they relate to both assigned functions and the overall effectiveness of the Health Services team. Work to resolve issues and improve processes and outcomes. Essential Responsibilities: Take a leadership role in the development, implementation, and ongoing operation and maintenance of assigned programs, services, or functions. Improve the performance of the department through effective oversight and coaching of team members, managing team performance and improving processes and outcomes. Monitor daily workflow and caseloads and other work processes of team to assure appropriate distribution and processing of tasks. Responsible for the orientation and training of new hires. Provide ongoing supervision, training, evaluation, and leadership to assigned team members. This may include annual reviews, involvement in promotions and/or terminations of employees. Participate in hiring decisions in concert with Appeals and Grievance Director and HR. Monitor and evaluate team assignments relating to volumes, timelines, accuracy, customer service, and other quality and performance measures, and take actions as appropriate. Assist with process improvement and work with other departments to improve interdepartmental processes. Utilize LEAN methodologies for continuous improvement. Monitor key performance indicators and identify improvement opportunities. Serve as liaison with other PacificSource departments or community partners to coordinate optimal provision of service and information. Serve on various internal and external committees as required or designated. Document and report any pertinent communications back to the team or department. Utilize and promote use of evidence-based medical criteria. Maintain modified caseload consistent with assigned responsibilities. Facilitate investigation and resolution of process-related issues as needed. Facilitate conflict resolution, including interfacing with affected departments and individuals, as appropriate. Oversee and assist in providing exceptional service and information to members, providers, employers, agents, and other external and internal customers. Provide backup to other departmental teams or management staff, as needed. Supporting Responsibilities: Meet department and company performance and attendance expectations. Relate new or revised policies, procedures and/or processes to team members to ensure they have the most up‐to‐date and current information. Facilitate team operations by discussions through the sharing of information and knowledge, identification of teamwork issues, development of problem‐solving recommendations, and recommendations of standardizing Health Services operations. Represent the Appeals and Grievance Department, both internally and externally, as requested by Appeals and Grievance Manager and/or Director. Perform other duties as assigned. Work Experience: A minimum of five years clinical experience required. Minimum of three years direct health plan experience in the following areas: utilization management, grievance and appeal, or claims review strongly preferred. Prior supervisory experience preferred. Education, Certificates, Licenses: Registered Nurse/Licensed Social Worker with current appropriate unrestricted state license. Within 6 months of hire licensure may need to include Oregon, Montana, Idaho, Washington and/or other states as needed. Knowledge: Knowledge of health insurance and state mandated benefits. Thorough knowledge and understanding of medical procedures, diagnoses, care modalities, procedure codes (including ICD-10, HCPC CPT codes). Effective adult education/teaching and/or group leadership skills. Ability to deal effectively with people who have various health issues and concerns. Strong analytical and organizational skills with experience in using information systems and computer applications. Flexible to meet the departments changing needs Ability to develop, review, and evaluate utilization and case management reports. Good computer skills including experience with Word, Excel, and PowerPoint. Ability to use audio-visual equipment. Ability to work independently with minimal supervision. Competencies Building Trust Building a Successful Team Aligning Performance for Success Building Customer Loyalty Building Strategic Work Relationships Continuous Improvement Decision Making Facilitating Change Leveraging Diversity Driving for Results Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 5% of the time. Skills: Accountable leadership, Collaboration, Communication (written/verbal), Critical Thinking, Decision Making, Influencing, Listening (active), Organizational skills/Planning and Organization Compensation Disclaimer The wage range provided reflects the full range for this position. The maximum amount listed represents the highest possible salary for the role and should not be interpreted as a typical starting wage. Actual compensation will be determined based on factors such as qualifications, experience, education, and internal equity. Please note that the stated range is for informational purposes only and does not constitute a guarantee of any specific salary within that range. Base Range: $83,212.29 - $137,300.29Our Values We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business: We are committed to doing the right thing. We are one team working toward a common goal. We are each responsible for customer service. We practice open communication at all levels of the company to foster individual, team and company growth. We actively participate in efforts to improve our many communities-internally and externally. We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community. We encourage creativity, innovation, and the pursuit of excellence. Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively. Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.

At Prime Therapeutics (Prime), we are a different kind of PBM, with a purpose beyond profits and a unique ability to connect care for those we serve. Looking for a purpose-driven career? Come build the future of pharmacy with us. **Job Posting Title** Pharmacy Technician II - MCP Clinical Liaison - Remote **Job Description** Evaluates and authorizes approval of prior authorization pharmacy requests from prescribers received by telephone and/or facsimile using client clinical criteria. **Responsibilities** + Determines appropriateness for medications. Communicates decision to physicians, physician`s office staff, medical management staff and/or pharmacists. Researches, resolves and documents prior authorization outcomes in pharmacy system. + Communicates selected prior authorization criteria, pharmacy benefit coverage and formulary alternatives to physicians, physician`s office staff, medical management staff and/or pharmacists. + Escalates requests to Pharmacist when request requires extensive clinical review or denial. + Monitors telephone system to ensure adequate staffing to maintain client services levels. + Assesses training needs within the team. Serves as a training resource, mentor and coach to others. Identifies and shares best practices. + Demonstrates, advocates and reinforces a positive team environment. + Other duties as assigned. **Minimum Qualifications** + GED or High School Diploma Required + Required CPT/ExCPT/LPT/PTCB/RPT, Pharmacy Technician, State Requirements - Pharmacy + 2+ years Pharmacy Must be eligible to work in the United States without the need for work visa or residency sponsorship **Additional Qualifications** + Must have an active pharmacy technician licensure or registration in accordance with state requirements. + If state does not require an exam for licensure/registration, must possess both active pharmacy technician licensure or registration in accordance with state requirements AND an active national certification (e.g., PTCB or ExCPT). + In states that do not require licensure or registration, must have an active national certification (e.g., PTCB or ExCPT). + Specialty or retail pharmacy industry experience, previous reimbursement experience, and/or working in a health plan/health care setting. + In-depth knowledge of specialty injectable prescription drugs, disease states, health plan formulary management techniques, medical terminology and current diagnostic and reimbursement coding (J/Q codes, ICD-9, CMS 1500, etc.). + Proficiency in Pharmacy computerized systems and software applications, as well as MS Office Product Suite. + Excellent written and verbal communication skills. + Ability to follow clinical criteria and instructions to approve prior authorization requests. + Minimum of 2 years dispensing or retail experience required, or equivalent internal training will be substituted. + Ability to identify and trouble-shoot problematic issues. **Preferred Qualifications** Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their job, and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures Every employee must be able to perform the essential functions of the job and, if requested, reasonable accommodations will be made to enable employees with disabilities to perform the essential functions, absent undue hardship. In addition, Prime retains the right to change or assign other duties to this job. Potential pay for this position ranges from $19.23 - $28.85 based on experience and skills. To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page (******************************************* and click on the "Benefits at a glance" button for more detail. _Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to_ _race, color, religion, gender, sex (including pregnancy), national origin, disability, age, veteran status, or any other legally protected class under federal, state, or local law._ _ _ _We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law._ _Prime Therapeutics LLC is a Tobacco-Free Workplace employer._ Positions will be posted for a minimum of five consecutive workdays. At Prime Therapeutics (Prime), we are a different kind of PBM. We're reimagining pharmacy solutions to provide the care we would want for our loved ones. That purpose energizes our team and creates limitless opportunities to make a difference. We know that people make all the difference. If you're ready for a purpose-driven career and are passionate about simplifying health care, let's build the future of pharmacy together. Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sex (including pregnancy), national origin, disability, age, veteran status, or any other legally protected class under federal, state, or local law. We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law. Prime Therapeutics LLC is a Tobacco-Free Workplace employer. If you are an applicant with a disability and need a reasonable accommodation for any part of the employment process, please contact Human Resources at ************** or email *****************************.

The Principal Financial Advisor is a strategic finance leadership role at the intersection of analysis, business strategy, and transformation. This position goes beyond traditional finance-it's about shaping decisions that drive financial operational expenses and organizational success. You will serve as a trusted advisor to senior leadership, delivering insights that influence strategy, optimize performance, and create measurable impact. This is a high-impact role for a finance leader who combines analytical rigor, strategic thinking, and exceptional communication skills-supported by modern financial systems-to deliver innovation and value. What You'll Do Works directly with staff and senior leadership across the company to proactively identify, prioritize, optimize and implement financial strategies and create meaningful and actionable outputs that drive the development of multi-year financial plans aligned to the company's overall strategic goals Proactively identify, evaluate, and implement financial strategies and plans, leveraging customer and consumer insights to drive business outcomes and maximize ROI, reducing risk and exposure and enable Blue Cross NC to meet growth and cost containment goals. Supports the development of corporate strategic positions on behalf of senior leadership and represents those positions internally and externally including financial modeling and development of executive presentations Builds and manages relationships and collaborates with both internal and external partners to drive highly complex financial analyses focused on significant business strategies and opportunities with substantial levels of importance and visibility Leads annual and long-term financial planning efforts and analyses; provides thought leadership at a divisional, cross-divisional, and enterprise level; prepares and presents results to executive leadership. Drives financial innovation and stewardship through collaboration and consultation with internal stakeholders to identify, plan and execute initiatives with significant financial impact. Partners with internal clients to better understand what problems they are trying to solve, help them articulate their vision and define financial impacts and success. Provides methods and resources to support their execution of those plans and quantification and realization of benefits Utilizes expertise to identify operational improvements and leads the development of new ideas to understand, estimate and minimize the financial impact of existing or emerging issues the business faces. Evaluates those ideas to determine viability and opportunity for success and follows through from implementation to value realization What You Bring Bachelor's degree or advanced degree (where required) 8+ years of experience in related field. In lieu of degree, 10+ years of experience in related field. Bonus Points Workday, Adaptive Planning, and OfficeConnect experience a plus What You'll Get The opportunity to work at the cutting edge of health care delivery with a team that's deeply invested in the community. Work-life balance, flexibility, and the autonomy to do great work. Medical, dental, and vision coverage along with numerous health and wellness programs. Parental leave and support plus adoption and surrogacy assistance. Career development programs and tuition reimbursement for continued education. 401k match including an annual company contribution Salary Range At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs. Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs. *Based on annual corporate goal achievement and individual performance. $98,092.00 - $156,947.00 Skills Finance, Finance Strategy, Financial Advising, Financial Analysis, Financial Execution, Financial Planning and Analysis (FP&A), Operational Process Improvements, Portfolio Management, Process Improvements, Resource Management, Strategic Planning, Strategic Thinking, Strategy Development, Wealth Management

Direct, manage and lead highly complex functional and/or broad foundational business areas within Payment Integrity to define and enable strategic and operational priorities. Lead and set goals for teams responsible for identifying, coordinating, and implementing initiatives/projects and activities that create efficiencies, optimize systems & processes, promote quality, and maximize medical and administrative expense savings. Teams may include Payment Integrity strategy and growth, operations, payment integrity clinical and specialty programs, and/or multiple payment integrity services either performed by vendors or internally. Leadership Responsibilities People leadership Resource management Project planning and management Financial and data analysis What You'll Do Provide leadership, vision, and direction for assigned teams. Direct staff of subject matter experts and analysts to identify & execute growth business initiatives, while managing existing programs: production problem resolution, system enhancements, and configurations. Accountable to define and execute strategy to deliver year-over-year growth and achieve savings target(s) within the COB and Data Mining vertical. Ensure business plans and industry analysis, consider future needs and drive “best in-class" thinking. Builds understanding of market trends and customer needs. Identifies new operational initiatives and modifications to current programs and processes to improve the company's competitive position/increase medical expense savings. Demonstrates understanding of the financial levers that impact business performance and deploys them to improve short- and long-term results. Lead and oversee management and delivery of enterprise and departmental projects including business case development, ROI analysis, planning, business analysis, and project management. Lead and oversee optimization of existing systems, processes, and workflows. Ensure programs and operations are performing successfully and are compliant in accordance with regulations of State, Federal, and other governing bodies; ensures corrective action plans are implemented when applicable. Develop internal PI Provider Education program to enhance provider experience and focus on change in behavior. What You'll Bring Bachelor's Degree 10 years of experience managing multifunctional payment integrity teams In lieu of bachelor's degree, 12 years of experience as stated above Must have direct health plan experience 7 years leadership experience Preferred skills Extensive knowledge of coordination of benefit primacy rules for commercial and Medicare lines of business, including knowledge of MSP demand process Basic claim coding knowledge for better understanding of data mining concepts Experience with project and software life cycle management Experience with vendor management from an operational perspective Experience with vendor contract negotiations Understanding of claims adjudication systems and pricing configuration and architecture Coding and billing experience What You'll Get: The opportunity to work at the cutting edge of health care delivery with a team that's deeply invested in the community Work-life balance, flexibility, and the autonomy to do great work Medical, dental, and vision coverage along with numerous health and wellness programs Parental leave and support plus adoption and surrogacy assistance Career development programs and tuition reimbursement for continued education 401k match including an annual company contribution Learn more Salary Range At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs. Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs. *Based on annual corporate goal achievement and individual performance. $157,978.00 - $252,765.00 Skills

At Prime Therapeutics (Prime), we are a different kind of PBM, with a purpose beyond profits and a unique ability to connect care for those we serve. Looking for a purpose-driven career? Come build the future of pharmacy with us. Job Posting TitleConsulting Business Analyst, Principal - Remote - Must be Located in CAJob Description The Consulting Business Analyst Principal provides strategic analytical leadership to guide enterprise-wide Business Systems Analysis (BSA) solutions, ensuring alignment with organizational goals. This role oversees enterprise-level regulations, compliance with Federal and State Rx policies, and evaluates technology investments to balance business value, security, and risk. The position integrates strategic vision with hands-on oversight to deliver consistent, compliant, and cost-effective BSA solutions that drive informed decision-making across the organization. This position needs to be located in the state of California due to contract obligations. Responsibilities Lead the strategic direction and implementation of enterprise changes to support scalable, policy-driven decision-making Analyze, evaluate, and optimize business, IT, or operational processes using structured methodologies such as Critical Thinking, Lean Management, ITIL, and Design Thinking Provide operational and strategic leadership across the full software development lifecycle (SDLC), mentoring Analysts and ensuring delivery excellence Partner with Architects to design scalable, compliant BI frameworks and reference data governance standards Identify and assess opportunities to apply emerging information technologies to enhance enterprise strategies, ensuring regulatory alignment with State and Federal Rx policy Drive successful installations, configurations, performance tuning, and system optimizations to support long-term business growth and compliance Support enterprise business development by producing recommendations, proposals, and strategic analysis to guide leadership decisions Champion industry best practices in Business Systems Analysis, mentoring and influencing the BA team to adopt robust methodologies, procedures, and frameworks Other Duties as assigned Minimum Qualifications Bachelors degree in Computer Science, Information Technology, or related area of study, or equivalent combination of education and/or relevant work experience; High school diploma or GED required 7 years of work experience in Healthcare Analytics/Informatics Must be eligible to work in the United States without the need for work visa or residency sponsorship Additional Qualifications Ability to translate complex business requirements into actionable technical solutions aligned with enterprise architecture and strategic goals Ability to identify solutions, define challenges, and drive organizational change through BI and analytics Demonstrated ability to balance compliance with enterprise regulations (State and Federal Rx) while optimizing BI systems for efficiency, scalability, and risk management Knowledge and ability to deliver high-quality BI projects on time while mentoring Analysts, fostering collaboration, and managing competing priorities effectively Preferred Qualifications PBM or health care experience CA-MMIS experience Experience leading enterprise-scale data models and analytical systems, leveraging Big Data, Cloud, and distributed technologies Demonstrated experience in business analysis on large complex projects or varying project types Experience using the SDLC process Experience working in Medicaid Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their job, and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures Every employee must be able to perform the essential functions of the job and, if requested, reasonable accommodations will be made to enable employees with disabilities to perform the essential functions, absent undue hardship. In addition, Prime retains the right to change or assign other duties to this job. Potential pay for this position ranges from $108,000.00 - $184,000.00 based on experience and skills. Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sex (including pregnancy), national origin, disability, age, veteran status, or any other legally protected class under federal, state, or local law. We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law. Prime Therapeutics LLC is a Tobacco-Free Workplace employer. Positions will be posted for a minimum of five consecutive workdays.

At Blue Cross and Blue Shield of North Carolina-we're a mission-driven organization committed to improving the health and well-being of our members and communities. Our employees are transforming healthcare through innovation, trust, and resilience. Our Enterprise Information Security team plays a critical role in safeguarding that mission. This is a hybrid role with frequent work from our Durham headquarters required. Position Overview: We are seeking a Chief Security Officer (DCSO) to join our leadership team. This is a rare opportunity to step into a well-established, high-performing security organization and lead it into its next chapter. This position will provide strategic and operational leadership for cybersecurity, ensuring that cyber risks are effectively managed within thresholds defined by the organization's risk appetite. This includes direct oversight of enterprise-wide cyber defense initiatives, governance frameworks, incident response protocols, and regulatory compliance. The role ensures that cybersecurity operations are tightly aligned with business objectives, and leads cross-functional teams to proactively identify, evaluate, and mitigate cyber threats that could compromise organizational resilience or financial integrity. This role is ideal for a healthcare-savvy executive who understands technology but leads first through relationships, influence, and strategic foresight. What Makes This Team Special: A deeply experienced team of upwards of 50 professionals many with tenure of 10+ years at Blue Cross NC A collaborative, strategy-setting culture with strong metrics and measures of success A shared commitment to continuous improvement, agility, and long-term impact Key Responsibilities: Backup and Continuity Serve as second-in-command to the CISO, stepping in during absences or crises Provide strategic counsel and operational continuity across the cybersecurity function Operational Oversight Lead day-to-day cybersecurity operations, including incident response, threat detection, and endpoint protection Oversee identity and access management, cybersecurity architecture, and engineering Advance the maturity of the organization's cybersecurity program by strengthening foundational capabilities, enhancing visibility across the environment, and improving threat detection and response effectiveness. Governance, Risk, and Compliance (GRC) Monitor audit controls and enterprise risk management practices Ensure compliance with HIPAA, NIST, HITRUST, and other regulatory frameworks Strategic Execution Execute cybersecurity roadmaps and strategic initiatives Partner across business units to embed security into enterprise operations Leadership and Talent Development Build and mentor high-performing teams Foster a culture of openness, agility, and psychological safety Champion diversity of thought and a willingness to challenge assumptions Ideal Candidate Profile: 10+ years of progressive leadership experience Deep understanding of healthcare industry dynamics and regulatory environments Proven ability to lead through influence, build trust, and drive cross-functional alignment Comfortable with ambiguity, risk, and being wrong-yet committed to learning and evolving Looking for a long-term employer where they can make a lasting impact North Carolina residence preferred Why Join Blue Cross NC? A purpose-driven culture focused on health equity and innovation Competitive compensation and benefits, including generous PTO, 401(k) match, and wellness programs Hybrid work flexibility and a commitment to work-life balance A chance to lead one of the most respected security teams in the healthcare industry Hiring Requirements: • Bachelor's degree or advanced degree (where required) • 10+ years of experience in related field • In lieu of degree, 12+ years of experience in related field.

Exceptional Opportunity: Endocrinology Physician Western Maryland Join a distinguished Endocrinology team at Western Maryland, a leading healthcare provider committed to delivering Life Changing Medicine. As an Endocrinology Physician, you'll work in a collaborative environment focused on exceptional patient care. Enjoy a balanced lifestyle with no call requirements, allowing you to prioritize both professional growth and personal well -being. Western Maryland offers a vibrant community with a rich mix of cultural and recreational activities. Opportunity Details As a member of our team, you will: Provide expert care in Endocrinology, demonstrating clinical excellence and compassionate patient interactions. Collaborate with a multidisciplinary team to enhance patient outcomes and advance medical knowledge. Contribute to the mission of improving community health through innovative, patient -centered care. Requirements MD or DO degree from an accredited medical school. Board Certification or Board Eligibility in Endocrinology. Current Maryland medical licensure or eligibility to obtain licensure. Benefits What We Offer We provide a competitive compensation package, including: Comprehensive medical, dental, and vision benefits. Opportunities for career advancement and professional development. Generous PTO and wellness programs to support work -life balance. Access to a robust retirement plan and other employee perks. Take the next step in your career with an organization dedicated to excellence and a team that values innovation and growth. Contact a Healthcare United representative today to learn more and apply!

The AVP Special Investigations Unit (SIU) is responsible for overseeing and managing fraud, waste, and abuse (FWA) detection, investigation, and prevention efforts to safeguard the organization's assets and reduce healthcare costs. This requires demonstrating vision in positioning the SIU with the right skill sets, cutting edge analytics tools, and robust processes to identify FWA schemes and direct investigations to resolve issues effectively and efficiently. The AVP will develop strategies to create and maintain an organization that has the flexibility, knowledge, business acumen, and capacity to successfully address the dynamic space of FWA. This role involves leading a matrixed team of investigators, analysts, and clinical/coding subject matter experts, working closely with internal and external stakeholders and ensuring compliance with regulatory requirements. The AVP SIU also will coordinate closely within the Payment Integrity team to flag (i.e., pend, review) suspect providers and develop pre-and post-payment approaches to the challenges of FWA. The AVP SIU requires externally facing credibility and leadership to collaborate with government regulators and the Blue Cross Blue Shield Association in connection with FWA investigation and reporting. What You'll Do Leadership: Lead and mentor a team of fraud investigators, analysts, and other staff, providing guidance and support in fraud detection, prevention, and recovery efforts. Establish team goals, monitor performance, and ensure alignment with organizational objectives. Collaborate internally with other departments to create and maintain a seamless claims payment integrity program. Serve as liaison with other key departments (Medical Management, Network Management, Data Analytics, Claims & Enrollment Operations) to develop, monitor, and update respective roles, responsibilities, and strategies related to claims payment integrity activities. Fraud Detection and Prevention: Work closely with analytics teams to contribute to the development of fraud detection strategies using data analytics, machine learning, and other advanced techniques to identify patterns of fraudulent behavior. Conduct risk assessments to identify vulnerabilities in the organization's processes and implement measures to mitigate these risks. Design and manage proactive fraud prevention programs to minimize exposure to fraudulent activities. Investigation Management: Oversee the management of the SIU's intake and investigative procedures and coordinate with Payment Integrity's prepayment analysts including workflow, productivity, accuracy, timeliness, and interaction with SIU and other Blue Cross NC staff members across the organization Ensure timely and accurate reporting of investigation findings and coordinate with legal, healthcare, and data teams to take appropriate action. Collaborate with law enforcement agencies, regulatory bodies, and external partners during investigations. Prepare comprehensive reports summarizing investigation outcomes, risk assessments, and fraud trends. Liaison with Blue Cross NC Legal department on all SIU/Legal interactions including communications with provider attorneys and determinations in the pursuit of criminal and civil actions. Compliance and Regulatory Adherence: Ensure all fraud investigation and prevention activities comply with state, federal, and industry regulations. Stay informed about changes in laws, regulations, and industry practices related to healthcare fraud. Assist in preparing documentation for audits, compliance reviews, and regulatory inquiries. As a critical component of the organization's Compliance Program, support law enforcement in the prosecution of unlawful activity directed against corporate and customer assets. Establish and maintain working relationships with governmental law enforcement agencies. Lead the development and delivery of educational awareness and training programs for the organization as part of the annual Code of Conduct training. Skills: Strong leadership and team management ability Excellent communication and presentation skills. Ability to work cross-functionally with various teams and external partners. What You Bring: Minimum 7+ years of experience in healthcare fraud detection, investigation, or auditing Bachelor's degree preferred in healthcare administration, finance, criminal justice, or related field/specialized training/relevant professional qualification. In-depth knowledge of healthcare systems claims processing, coding/reimbursement, and regulatory requirements related to healthcare fraud. Minimum 5+ years in a leadership role. Bonus Points (preferred qualifications) : Relevant certifications (e.g., Certified Fraud Examiner (CFE), accredited healthcare fraud investigator (AHFI) What You'll Get: The opportunity to work at the cutting edge of health care delivery with a team that's deeply invested in the community Work-life balance, flexibility, and the autonomy to do great work Medical, dental, and vision coverage along with numerous health and wellness programs Parental leave and support plus adoption and surrogacy assistance Career development programs and tuition reimbursement for continued education 401k match including an annual company contribution Learn more Salary Range At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs. Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs. *Based on annual corporate goal achievement and individual performance. $191,153.00 - $305,845.00 Skills

At Prime Therapeutics (Prime), we are a different kind of PBM, with a purpose beyond profits and a unique ability to connect care for those we serve. Looking for a purpose-driven career? Come build the future of pharmacy with us. Job Posting TitleTrainer Associate - RemoteJob Description The Associate Training Trainer in training development and leads or co-leads in deployment. This position supports the department Trainers, subject matter experts and other training professionals to design and develop, training programs, as needed, for internal customers and leads the facilitation of training classes. Responsibilities Deliver training in either a face-to-face synchronous environment and/or the asynchronous work from home format with materials provided for new hire classes Assist with coordinating training class administrative functions and prepare materials for training functions and meetings Support content development, design and facilitation of training modules; track learner questions/challenges and follow up with answers Participate in all elements of training design, development, and project management including conducting focus groups for training rollout Other duties as assigned Minimum Qualifications Bachelor's Degree in Business, Human Resources, Training, Education, Organizational Development, or related area of study, or equivalent combination of education and/or relevant work experience; HS diploma or GED is required. Must be eligible to work in the United States without the need for work visa or residency sponsorship Additional Qualifications Effective verbal and written communication skills including documentation writing experience Strong attention to detail and accuracy Strong organizational skills Preferred Qualifications Bachelor's Degree PBM/health care experience Experience with Microsoft Office Products including Excel, Word and PowerPoint Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their job, and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures Every employee must be able to perform the essential functions of the job and, if requested, reasonable accommodations will be made to enable employees with disabilities to perform the essential functions, absent undue hardship. In addition, Prime retains the right to change or assign other duties to this job. Potential pay for this position ranges from $23.08 - $37.02 based on experience and skills.To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page and click on the "Benefits at a glance" button for more detail. Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sex (including pregnancy), national origin, disability, age, veteran status, or any other legally protected class under federal, state, or local law. We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law. Prime Therapeutics LLC is a Tobacco-Free Workplace employer. Positions will be posted for a minimum of five consecutive workdays.

Looking for a way to make an impact and help people? Join PacificSource and help our members access quality, affordable care! PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, sex, sexual orientation, gender identity, national origin, genetic information or age. PacificSource values the diversity of our community, including those we hire and serve. We are committed to creating and fostering a work environment in which individual differences and diversity are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths. The Senior Director, Product and Regulatory Management is responsible for leading teams in three key domains: 1) the development, implementation, and management of the end-to-end product lifecycle for Medicare and commercial lines of business; 2) efficient and effective commercial business administration; and 3) compliant and effective regulatory communications. Working with company leadership, the Senior Director is responsible for developing and implementing products that achieve membership and profitability targets. In support of strategic business plans developed by the leaders responsible for profit and loss of the lines of business, this position ensures the product lifecycles, annual roadmaps, filings, and communications meet business needs. The Senior Director ensures the organization complies with product, filing, and communication-related processes and timelines, as well as manages major milestones, risk and mitigation planning, tracking and reporting, and communication across the organization. The Senior Director leads product strategy, development, the annual bid process, and corresponding initiatives. The product portfolio includes Medicare Advantage, Dual Special Needs Plan (DSNP), fully insured group business, and Individual offerings, on and off exchange, as well as corresponding regulated filings and materials. The communications portfolio supports regulated communications, predominantly for Medicare Advantage, DSNP, and Medicaid plans. The Senior Director manages a leadership team to deliver on this critical work. Essential Responsibilities: Lead the product portfolio development and execution strategy across segments and multiple plan years. Direct the Medicare and Commercial product strategy and portfolio management to ensure profitable growth consistent with business plans. Oversee each step of the work from development to assessment and implementation. Lead, coordinate, and communicate product and lifecycle activities with others in the organization. Oversee successful and timely annual bids, filings, related regulatory submissions, and go-to-market activities. Oversee development and deployment of regulatory communication materials and processes, including Annual Notice of Change, directories, Evidence of Coverage, handbooks, formulary materials, forms, letters, and other regulated materials. Oversee the preparation of all filings and compliant regulatory documents across the product portfolio, including health contracts, self-funded materials, and related documents. Oversee implementation of state and federal benefit mandates, including benefit changes and member communication requirements. Provide strategic advice for PacificSource teams to ensure plan information is accurate and available timely within required timeframes. Ensure proactive communication of new and revised plan designs and benefits to internal stakeholders. Develop and improve processes, driving administrative efficiencies and cost savings, including leading in a matrixed environment and emphasizing execution, market positioning, and operational tactics. Drive operational excellence, sustainability, and profitable growth. Generate local competitive market insights to drive innovation and decision making. Conduct market research, competitive analysis, and financial assessments to evaluate improvement opportunities and business strategies in concert with PacificSource's enterprise strategy. Implement strategies across segments and markets. Develop structures and processes to ensure compliance, including leading cross-functional teams. Collaborate with Marketing, Sales, Operations, Health Services, and Compliance. Develop strategic business partnerships with internal departments and leaders to ensure strong operating performance, high member satisfaction and quality performance, access, compliance and audit readiness, and sound financial performance. Work closely with Compliance and others to ensure policies, procedures, workflows, lifecycle strategies, product offerings, and success initiatives comply with state and federal regulations. Participate in compliance audits, activities, and planning. Negotiate business relationships with vendors and oversee the execution, implementation, and oversight of the contracts. Develop and monitor departmental budgets and take corrective action as necessary. Provide leadership and mentoring to the enterprise product team, the business administration team, and the regulatory communications team. Foster leadership development and advancement. Develop succession plans. Manage, coach, motivate, and guide employees. Support the organization's commitment to diversity, equity, inclusion, and belonging by fostering a culture of dignity, cultural awareness, compassion, and respect. Supporting Responsibilities: Meet department and company performance and attendance expectations. Follow the PacificSource privacy policy HIPAA laws, and regulations concerning confidentiality and security of protected health information. Perform other duties as assigned. SUCCESS PROFILE Work Experience: Minimum of eight years of experience in product, portfolio, lifecycle management, and regulated communications, or substantially equivalent work in highly regulated functions. Exemplary work history with a proven record of success in positions of progressively greater responsibility managing people and achieving business goals and objectives. A solid grasp of the managed care field and insurance regulations is crucial for this role. Experience with strategic planning, communications, sales, product development, regulatory filings, and managing teams required. Leadership experience in a managed care organization requiring advanced knowledge of products, regulatory filings, and regulated communications. Experience with end-to-end product development and lifecycle management of Medicare Advantage, Individual, and group segments, on and off exchange. Experience providing oversight to ensure the successful regulatory filing of all required product materials. Demonstrated success working in a matrixed environment with the ability to set a path and inspire others to follow. Proven record of accomplishment as a driver of process improvement and identifier of efficiency opportunities and ability to lead change. Experience with federal and state regulatory compliance for health insurance plans. Proven ability to quickly assimilate information and make informed decisions; logical, analytical thinker with great influencing abilities; and ability to handle multiple priorities and deal with ambiguity. Education, Certificates, Licenses: Bachelor's degree required with a focus in health care administration, business, public policy, public health, or a related field. Master's degree or other advanced degree preferred. Knowledge: Advanced knowledge of Medicare Advantage, DSNP, fully insured group business, and Individual, on and off exchange, along with a deep understanding of the key attributes, competencies, and strategies for success. Advanced knowledge of state and federal regulations. Knowledge of self-funding arrangements is preferred but not required. Strong understanding of managed care and publicly financed or subsidized health care, including the intersection between retail Medicare Advantage, DSNP, and Medicaid. Demonstrated experience and success in working collaboratively in defining and achieving common goals. Ability to communicate, persuade, influence, and negotiate effectively. Comprehensive knowledge of business principles and administration, organization, and management activities, including knowledge of infrastructure and operational requirements needed to comply with regulatory mandates. Excellent verbal and written communication skills. Solid organizational and problem-solving skills with a keen eye for detail. Proficiency in analyzing market trends, conducting competitive research, and developing strategic product and portfolio roadmaps is essential for success. The ability to multitask, prioritize competing demands, and adapt to a changing regulatory environment is key. Competencies Authenticity Establishing strategic direction Customer focus Leading change Empowerment/delegation Building organizational talent Coaching and developing others Passion for results Cultivating networks Emotional intelligence Optimizing diversity Environment: Work remotely and inside in a general office setting with ergonomically configured equipment. Travel is required approximately 20% of the time. Skills: Accountable leadership, Business & financial acumen, Empowerment, Influential Communications, Situational Leadership, Strategic Planning Our Values We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business: We are committed to doing the right thing. We are one team working toward a common goal. We are each responsible for customer service. We practice open communication at all levels of the company to foster individual, team and company growth. We actively participate in efforts to improve our many communities-internally and externally. We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community. We encourage creativity, innovation, and the pursuit of excellence. Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively. Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.

At Prime Therapeutics (Prime), we are a different kind of PBM, with a purpose beyond profits and a unique ability to connect care for those we serve. Looking for a purpose-driven career? Come build the future of pharmacy with us. Job Posting TitleIT Systems Analyst - RemoteJob Description The IT Systems Analyst is responsible for utilizing various delivery methodologies employed by Prime and assist in the communications interface between IT and the business community in the investigation, identification, and documentation of business application requirements and technical solutions based on applicable technologies within Prime for either the enhancement of existing applications or to foster the development of new applications. Responsibilities Manage application servers including: Installation & Configuration: Determine necessary software and configuration settings to meet requirements and ensure compatibility. Monitoring & Performance Management: Detect and resolve issues such as slow response times, high resource usage, and downtime using performance metrics. Troubleshoot and resolve application-related issues to maintain optimal performance and reliability. Understand integrations between applications and coordinate with vendors, business users, and IT teams for support and management. Implement security measures in collaboration with vendors and internal teams, including certificate management, encryption, vulnerability remediation, and patching. Coordinate with vendors and security teams to enforce access management and authentication policies. Evaluate and recommend infrastructure platform upgrades to support evolving business needs. Analyze interconnections between application components and develop tools for seamless integration. Adhere to organizational policies for Incident, Problem, Change, Security, and Disaster Recovery Management. Other duties as assigned. Minimum Qualifications Bachelor's degree in Computer Science or related area of study, or equivalent combination of education and/or relevant work experience; High School Diploma or GED equivalent required 2 years of experience supporting key business applications Must be eligible to work in the United States without need for work visa or residency sponsorship Must be eligible to work in the United States without the need for work visa or residency sponsorship Additional Qualifications Strong problem-solving and analytical skills. Ability to work independently and collaboratively in a highly matrixed environment. Strong documentation and communication skills. Ability to coordinate across multiple vendors and internal teams. Preferred Qualifications Experience with Windows Server administration. Experience with Java application servers (e.g., Wildfly) and performance tuning. SQL Server experience, including writing queries and troubleshooting performance issues. Familiarity with IT Service Management practices (Incident, Problem, Change Management). Experience working in environments with regulatory compliance requirements (HIPAA, PCI, etc.). Previous experience in pharmacy operations or PBM/healthcare industry. Understanding of security implications and best practices for application domains. Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their job, and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures Every employee must be able to perform the essential functions of the job and, if requested, reasonable accommodations will be made to enable employees with disabilities to perform the essential functions, absent undue hardship. In addition, Prime retains the right to change or assign other duties to this job. Potential pay for this position ranges from $74,000.00 - $118,000.00 based on experience and skills.To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page and click on the "Benefits at a glance" button for more detail. Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sex (including pregnancy), national origin, disability, age, veteran status, or any other legally protected class under federal, state, or local law. We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law. Prime Therapeutics LLC is a Tobacco-Free Workplace employer. Positions will be posted for a minimum of five consecutive workdays.

Founded in 2011, World is one of the fastest-growing insurance brokers in the U.S. with over 2,200 employees in over 210 offices across North America. We specialize in personal and commercial insurance lines, surety and bonding, employee benefits, financial and retirement services, and human capital management solutions. At World Insurance, you'll be part of a collaborative team dedicated to delivering best-in-class financial and analytical support to employee benefits clients. This role offers the opportunity to deepen your expertise in underwriting and analytics and grow within the practice while playing a key role in helping employers make smarter benefits decisions. Position Overview World Insurance is seeking an experienced Employee Benefits Underwriting & Financial Analyst to join our Underwriting & Analytics team. In this role, you will analyze financial and contractual information for current and prospective clients ranging from fully insured to self-funded arrangements. You'll prepare financial deliverables, model renewals, evaluate utilization trends, and support client decision-making with data-driven insights. You'll work closely within a team of underwriters & financial analysts, while also collaborating with our service teams to deliver high-quality support to clients. Key Responsibilities Manage and prioritize analytical workflow to ensure accurate, timely deliverables. Prepare and maintain financial dashboards for a book of business (clients typically 100-500 employees). Client funding arrangements may range from fully insured, level funded, and self-funded. Conduct standard client analyses in alignment with the service calendar, including: Market review analysis Renewal rate and funding initial projections/modeling Claims utilization review Rate and contribution modeling Benchmarking studies Self-funded feasibility analysis Technical review of group insurance contracts and financial arrangements Follow established procedures to utilize systems such as BenefitPoint, PerfectQuote, and others. Collaborate with subject matter experts, including Population Health Management, to deliver holistic client solutions. Develop alternative plan strategies, models, and cost-reduction opportunities using analytical tools and templates. Act as primary contact with carriers for marketing, quoting, and renewals; request, evaluate, and negotiate proposals. Build and maintain excellent relationships with carrier partners. Draft client-facing executive summaries, including findings, observations, and recommendations. Prepare formal correspondence such as carrier renewal confirmations and client renewal letters. Participate in the peer review process to ensure accuracy and quality. Provide prospect and ad hoc analytical support as needed. Perform other duties as assigned. Qualifications 2-3+ years of experience in employee benefits, insurance, or a related field. College degree or CEBS designation preferred. Life & Health insurance license, or willingness to obtain within 90 days of hire. Ability to work in a fast-paced environment with some oversight and a high degree of accuracy and attention to detail. Advanced proficiency in Microsoft Excel (formulas, modeling, formatting) with strong skills in Word and other MS Office tools such as Power BI. Understanding and/or prior use of Claros, Blue Raven, or other actuarial modeling tools is ideal. Technical experience with BenefitPoint, AI, Benefit Administration Systems, and Carrier Portals is preferred. Strong analytical, problem-solving, and critical thinking abilities, with the ability to work with complex data and variables. Excellent written, oral, and interpersonal communication skills. Team-oriented, client-focused, and able to build effective working relationships with colleagues, carriers, and clients. Commitment to staying current on industry trends, regulations, and emerging products. Compensation: This is a remote position. The base salary at the time of this posting may range from $80,000-$90,000. Individual compensation varies based on job-related factors, including business needs, experience, level of responsibility, and qualifications. We offer a competitive benefits package and variable pay programs, please visit ************************************** for more details. Equal Employment Opportunity At World Insurance Associates (WIA), we celebrate and support our differences. We know employing a team rich in diverse thoughts, experiences, and opinions allows our employees, our products, and our community to flourish. WIA is honored to be an equal opportunity workplace. We are dedicated to equal employment opportunities regardless of race, color, ancestry, religion, sex, national orientation, age, citizenship, marital status, disability, gender identity, sexual orientation, or Veteran status. In addition, WIA makes reasonable accommodations to known physical or mental limitations of an otherwise qualified applicant or employee with a disability, unless the accommodation would impose an undue hardship on the operation of our business. To Executive Search Firms and Staffing Agencies: World does not accept unsolicited resumes from any agencies that have not signed a mutual service agreement. All unsolicited resumes will be considered World's property, and World will not be obligated to pay a referral fee. This includes resumes submitted directly to Hiring Managers without contacting World's Human Resources Talent Department. #LI-MA1 #LI-REMOTE