Your Role The Cloud Engineering team is a cross functional group responsible for the advancement and support of the Blue Shield multi cloud presence. The Cloud Network Engineer, Consultant will report to the Manager, Cloud Engineering. In this role you will have a broad and deep impact on how Blue Shield achieves its business and technical goals by leveraging cloud techno

Your Role The Appeals and Grievance Department Regulatory team is responsible for responding to inquiries received directly from our state regulatory agencies. The Regulatory Complaint Coordinator, Intermediate, will report to the Regulatory Complaint Supervisor. In this role you will be responsible for effectively managing your time daily to ensure you are meeting and/or

Your Role The Blue Shield of California Commercial Finance team is responsible for providing financial planning and analysis support for the mid to large segment employer groups. The Financial Analyst, Senior will report to the Sr. Manager, Finance Analytics. In this role, you will be responsible for the monthly membership close deliverables which includes analysis, repor

Your Role The Provider Network Management team consists of Provider Relations and Contracting in Northern California. The Provider Contracting Specialist, Principal will report to the Director, Provider Contracting. In this role you will be responsible for managing contract negotiations for select providers in Central and Northern California. The job entails comprehensive

Your Role Pharmacy Readiness and Incident Management (PRIM) is a governance process and team within Pharmacy Services that logs, manages, and communicates the impact and resolution of all pharmacy impacting issues. PRIM proactively monitors and communicates Pharmacy Operational Readiness activities, milestones, and risk mitigations for both Blue Shield of California (BSC)

Our FEP (Federal Employee Program) Customer Experience Teams receive incoming telephone calls from healthcare providers and active and retired Federal Employees. Call Centers are open Monday Friday from 8 00am to 4 30pm. This position is a hybrid remote position, not office based, which may require you to travel to the office a few times a year. If hired, you will be requ

Start dates from August 2024 October 2024 Mandatory Training Virtual As a Senior Markets Customer Service Representative (CSR), you are in charge of upholding our mission of providing service worthy of our family and friends. Our members look to you to help them navigate healthcare, providing empathy and advocacy. You are empowered to provide members with peace of mind th

Start dates from August 2024 October 2024 Mandatory Training Virtual As a Senior Markets Customer Service Representative (CSR), you are in charge of upholding our mission of providing service worthy of our family and friends. Our members look to you to help them navigate healthcare, providing empathy and advocacy. You are empowered to provide members with peace of mind th

Your Role The Salesforce Platform & Operations Team is focused on optimizing Salesforce solutions and maximizing value across the enterprise. Salesforce is an enterprise platform targeted to help accelerate our transformation program, enable innovation, and help realize our vision for a reimagined healthcare system. Our team works cross functionally to link our key busine

Your Role The Quality Review team completes internal audits of front line staff and vendors to ensure alignment with department processes and regulatory compliance. Quality Reviewers also provide coaching and work closely with business leaders to drive optimal results. The Manager of Quality Review will report to the Senior Manager of the Quality & Communications team. In

Your Role The Clinical Quality team oversees and is responsible of HEDIS medical record review, pursuit, and overall HEDIS submission. The Clinical Quality Coordinator will report to the Supervisor of the HEDIS Outreach Team. In this role you will be responsible for conducting provider outreach during the HEDIS season for medical record pursuit and retrieval. Also, partic

Your Role The Clinical Quality team oversees and is responsible of HEDIS medical record review, pursuit, and overall HEDIS submission. The Clinical Quality Coordinator will report to the Supervisor of the HEDIS Outreach Team. In this role you will be responsible for conducting provider outreach during the HEDIS season for medical record pursuit and retrieval. Also, partic

Your Role The Data & Analytics (D&A) team focuses enterprise wide to partner with business stakeholders to apply the power of data & analytics to deliver new insights and data driven solutions to accelerate business outcomes. The Medical Informatics Analyst, Principal will report to the Senior Manager, Medical Informatics (Value Based and Medical Care Solutions Analytics)

Your Role The Duals Outreach & Enrollment Manager is responsible for planning and executing beneficiary education, enrollment, community events, meetings, and conducting provider education and outreach for the purpose of growth and retention. The Duals Outreach & Enrollment Manager will report to the Senior Manager, Duals Outreach and Enrollment. In this role you will be

Your Role The Utilization Management team reviews the inpatient stays for our members and correctly applies the guidelines for nationally recognized levels of care. The Utilization Management Nurse will report to the Utilization Management Nurse Manager. In this role you will be assigned a list of inpatient facilities and then review clinical information provided by the f