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The hiring range for this role is: &nbsp;142,690.17 - 219,876.89This is the lowest to highest salary we, in good faith, believe we would pay for this role at the time of this posting.&nbsp; We may ultimately pay more or less than the hiring range andthis hiringrange may also be modified in the future. A candidate’s position within the hiring range may be based on several factors including, but not limited to, specific competencies, relevant education, qualifications, certifications, relevant experience, skills, seniority, performance, shift, travel requirements, and business or organizational needs.&nbsp;This job is also eligible for annual bonusincentivepay.We offer a comprehensive package of benefits including paid time off, 11 holidays, medical/dental/vision insurance, generous 401(k) matching, lifestyle spending account and many other benefits to eligible employees.Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.Job Description Summary: The Healthcare Solutions Counsel provides legal and strategic guidance to the organization’s business operations team on matters related to the healthcare industry. This role focuses on supporting initiatives that expand access to healthcare nationwide, including advising on regulatory requirements and contractual arrangements tied to healthcare solution implementation. The position also involves collaboration with legal and business teams across affiliated health plans to support the development, execution, and ongoing operations of systemwide healthcare programs.Responsibilities include but are not limited to:<ul><li>Identify and assess legal risks for moderately complex matters for assigned practice area with minimal supervision and direction. Assigned practice area may include one or more of the following litigation, special investigations, legal operations, healthcare/regulatory law, contracts, etc.</li><li>Builds knowledge of the business context</li><li>Performs routine legal work.</li><li>Handles moderately complex legal questions and projects.</li></ul>Required Education, Certifications and Experience: Education:<ul><li>Required Juris Doctor</li></ul>Experience:<ul><li>5+ Years legal practice experience Required</li></ul> Knowledge Skills and Abilities:<ul><li>Proficient written and oral communication skills</li><li>Proficient organizational and project management skills, including follow through skills</li><li>Strong legal research, analysis and drafting</li><li>Problem solving skills</li><li>Preferred knowledge of healthcare insurance industry, including state and federal regulatory environment</li></ul>Certifications &amp; Licenses:<ul><li>Required: Bar Admission - Various</li></ul> Additional experience preferred:<ul><li>Legal practice experience, practice experience in contracts, corporate law, health law, HIPAA/privacy, litigation, and/or health insurance law</li></ul>#LI_HYBRID

Blue Cross Blue Shield Association

Associate General Counsel, Health Care Solutions

The hiring range for this role is: &nbsp;142,690.17 - 219,876.89This is the lowest to highest salary we, in good faith, believe we would pay for this role at the time of this posting.&nbsp; We may ultimately pay more or less than the hiring range andthis hiringrange may also be modified in the future. A candidate’s position within the hiring range may be based on several factors including, but not limited to, specific competencies, relevant education, qualifications, certifications, relevant experience, skills, seniority, performance, shift, travel requirements, and business or organizational needs.&nbsp;This job is also eligible for annual bonusincentivepay.We offer a comprehensive package of benefits including paid time off, 11 holidays, medical/dental/vision insurance, generous 401(k) matching, lifestyle spending account and many other benefits to eligible employees.Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.Job Description Summary: The Litigation &amp; Risk team identifies, mitigates, and manages Blue Cross Blue Shield Association's (BCBSA) risks, including litigation-related risk having a significant impact on BCBSA and BCBS Plans. This role manages and collaborates across the organization to provide legal team support of Systemwide litigation, including partnering with outside counsel on discovery and case strategy, managing within a litigation budget, collaborating with BCBSA leadership and Blue System litigation counsel on case strategy, and supporting business teams with of Systemwide business changes. Additionally, this role provides legal advice and counsel to BCBSA leadership on the operation of BCSBA’s antitrust compliance program.Responsibilities include but are not limited to:<ul><li>Assigned practice area may include one or more of the following litigation, special investigations, legal operations, healthcare/regulatory law, contracts, etc.</li><li>Identify and assess legal risks for moderately complex matters for assigned practice area with minimal supervision and direction. Assigned practice area may include one or more of the following litigation, special investigations, legal operations, healthcare/regulatory law, contracts, etc. 30%</li><li>Builds knowledge of the business context 30%</li><li>Performs routine legal work. 20%</li><li>Handles moderately complex legal questions and projects. 20%</li></ul>Required Education, Certifications and Experience: Education:<ul><li>Required Juris Doctor</li></ul>Experience:<ul><li>5+ Years legal practice experience required</li></ul>Knowledge Skills and Abilities:<ul><li>Strong written and oral communication skills</li><li>Strong organizational and project management skills, including follow through skills</li><li>Strong legal research, analysis and drafting</li><li>Problem solving skills</li><li>Preferred knowledge of healthcare insurance industry, including state and federal regulatory environment</li></ul>Certifications &amp; Licenses:<ul><li>Required: Bar Admission - Various</li></ul>Additional information:<ul><li>Legal practice experience, practice experience in contracts, corporate law, health law, HIPAA/privacy, litigation, and/or health insurance law</li><li>Knowledge, Skills and Abilities:</li><li>Strong written and oral communication skills</li><li>Strong organizational and project management skills, including follow through skills</li><li>Strong legal research, analysis and drafting</li><li>Problem solving skills</li><li>Preferred knowledge of healthcare insurance industry, including state and federal regulatory environment</li></ul>#LI_HYBRID

Associate General Counsel

The hiring range for this role is: &nbsp;$103,676.95 - $159,759.88This is the lowest to highest salary we, in good faith, believe we would pay for this role at the time of this posting.&nbsp; We may ultimately pay more or less than the hiring range andthis hiringrange may also be modified in the future. A candidate’s position within the hiring range may be based on several factors including, but not limited to, specific competencies, relevant education, qualifications, certifications, relevant experience, skills, seniority, performance, shift, travel requirements, and business or organizational needs.&nbsp;This job is also eligible for annual bonusincentivepay.We offer a comprehensive package of benefits including paid time off, 11 holidays, medical/dental/vision insurance, generous 401(k) matching, lifestyle spending account and many other benefits to eligible employees.Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.Responsible for overseeing all Utilization Management (UM) and Medical Policy deliverables within the organization. This includes identification, implementation, oversight, management, and evaluation of UM and Medical Policy program functions and initiatives. Serves as a clinical and technical expert, provides technical guidance and education to internal and external business partners regarding UM and Medical Policy clinical criteria and industry standards. Conducts systematic analysis to evaluate evidence-based clinical guidelines to develop and update medical policies. Additionally, reviews and evaluates new benefits, participate in complex projects, and ensures medical policy documentation aligns with benefit design and contractual obligations, supporting program performance assessment and accreditation.<li>Act as a liaison, resource, and clinical subject matter expert to internal and external business partners. Provide guidance on utilization management and medical policy activities, ensuring the development and implementation of required strategies, programs, and products. Promote and reinforce Plans’ accountability for achieving business outcomes, while providing ongoing monitoring, evaluation, and revision of guidelines as needed 25%</li><li>Conduct systematic reviews of evidence-based reference policy documents and current clinical literature to develop and update medical policies. Ensure consistency with benefit design, contractual obligations, and program/accreditation requirements. Adhere to the medical policy review cycle schedule, lead content development for draft documents, and prepare and present medical policy content and review procedures to the Pharmacy and Medical Policy Committee for approval 25%</li><li>Manage critical escalations that have external visibility and impact member and provider satisfaction. Evaluate options and work with BCBS Plans for resolution. Identify and manage risks, resolve conflicts, and remove barriers that impede Plans’ ability to achieve goals and performance expectations 25%</li><li>Contribute to cross-functional teams by interpreting utilization data, medical coding, and policy research. Translate trend information into strategic action plans, resulting in value-added resources and programs that address business needs and support program strategic initiatives 15%</li><li>Lead background clinical research on current and emerging technology areas, including the FDA approval or clearance status of FDA-regulated products. Synthesize, summarize, and present information to internal and external business partners as the evidence basis for medical necessity and experimental/investigational determinations 10%</li> Job Overview: Responsible for overseeing all Utilization Management (UM) and Medical Policy deliverables within the organization. This includes identification, implementation, oversight, management, and evaluation of UM and Medical Policy program functions and initiatives. Serves as a clinical and technical expert, provides technical guidance and education to internal and external business partners regarding UM and Medical Policy clinical criteria and industry standards. Conducts systematic analysis to evaluate evidence-based clinical guidelines to develop and update medical policies. Additionally, reviews and evaluates new benefits, participate in complex projects, and ensures medical policy documentation aligns with benefit design and contractual obligations, supporting program performance assessment and accreditation. Essential Functions<ul><li>Act as a liaison, resource, and clinical subject matter expert to internal and external business partners. Provide guidance on utilization management and medical policy activities, ensuring the development and implementation of required strategies, programs, and products. Promote and reinforce Plans’ accountability for achieving business outcomes, while providing ongoing monitoring, evaluation, and revision of guidelines as needed</li><li>Conduct systematic reviews of evidence-based reference policy documents and current clinical literature to develop and update medical policies. Ensure consistency with benefit design, contractual obligations, and program/accreditation requirements. Adhere to the medical policy review cycle schedule, lead content development for draft documents, and prepare and present medical policy content and review procedures to the Pharmacy and Medical Policy Committee for approval</li><li>Manage critical escalations that have external visibility and impact member and provider satisfaction. Evaluate options and work with BCBS Plans for resolution. Identify and manage risks, resolve conflicts, and remove barriers that impede Plans’ ability to achieve goals and performance expectations</li><li>Contribute to cross-functional teams by interpreting utilization data, medical coding, and policy research. Translate trend information into strategic action plans, resulting in value-added resources and programs that address business needs and support program strategic initiatives</li><li>Lead background clinical research on current and emerging technology areas, including the FDA approval or clearance status of FDA-regulated products. Synthesize, summarize, and present information to internal and external business partners as the evidence basis for medical necessity and experimental/investigational determinations</li></ul>QualificationsEducation <ul><li>Required Bachelor's Degree in nursing or related field from an accredited university; or equivalent work experience</li><li>Preferred Master's Degree</li><li>Experience </li><li>5+ Years of experience with Utilization Management and Medical Policy development in a managed care setting Required</li><li>Knowledge Skills and Abilities </li><li>Excellent written and verbal communication skills Ability to translate complex, technical and/or quantitative information in clear, concise, and understandable documents of presentation Advanced project management skills for planning and executing multiple projects and a detail orientation to ensure compliance with accreditation standards and accuracy of statistics Demonstrated ability to identify and create strategies that support initiatives and translate these into strategic action plans Ability to work well in an interdisciplinary clinical team environment Demonstrated ability to foster strong working relationships with customers and business stakeholders and contact Demonstrated ability to handle multiple projects, prioritizing critical aspects/tasks, working under pressure and meeting deadlines Ability to lead independent research Technical proficiency with information technologies (e.g. Microsoft Office) and literature-search databases Demonstrated abilities in data analysis, synthesis, and reporting, including systematic analysis of clinical literature Ability to conduct comparative analysis of external medical policies, with detailed analysis of specific clinical indications Demonstrated ability to understand complex medical technology assessments and detailed analysis of specific clinical indications in medical policies</li><li>Certifications &amp; Licenses </li><li>Required: RN-CS - RN Certified Clinical Specialist -</li><li>Preferred: CPHM - Certified Professional in Healthcare Management - AIHM</li><li>Preferred: Certified Professional Coder (CPC) - AAPC</li><li>Preferred: Accredited Case Manager (ACM) - ACMA</li></ul> Extra Posting information: A minimum of four years of experience with Utilization Management and Medical Policy development in a managed care setting. Experience with URAC/NCQA accreditation requirements. Experience presenting information to large audiences (town hall calls, professional conferences, etc.), both virtually and in-person. Experience in leading cross-functional work Experience related business experience which demonstrates knowledge and understanding of PPO operations, business practices and processes, as well as knowledge of corporate goals.#LI-Hybrid

Utilization Senior Program Manager (Registered Nurse)

The hiring range for this role is: &nbsp;$150,000.00 - $175,000.00This is the lowest to highest salary we, in good faith, believe we would pay for this role at the time of this posting.&nbsp; We may ultimately pay more or less than the hiring range andthis hiringrange may also be modified in the future. A candidate’s position within the hiring range may be based on several factors including, but not limited to, specific competencies, relevant education, qualifications, certifications, relevant experience, skills, seniority, performance, shift, travel requirements, and business or organizational needs.&nbsp;This job is also eligible for annual bonusincentivepay.We offer a comprehensive package of benefits including paid time off, 11 holidays, medical/dental/vision insurance, generous 401(k) matching, lifestyle spending account and many other benefits to eligible employees.Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.Responsible for providing technical leadership, analysis and design facilitation across business, information and technical viewpoints and enterprise architecture. This hands-on role will establish Synergie’s solution architecture strategy. In collaboration with the chief architect, responsible for leading the effective integration of the Enterprise Architecture process with other related processes. In this leadership role, you will work across internal departments and external technology partners to evaluate our existing infrastructure and lead the hands-on design, development, and deployment of innovative healthcare business applications. You’ll help shape the future of our technology landscape by identifying key opportunities for improvement and translating them into actionable development initiatives. You will take ownership of defining technical requirements for strategic projects, managing priorities, and ensuring that deliverables meet both business needs and technical standards. Your work will involve guiding cross-functional teams and external consultants to deliver high-quality solutions on time and within scope. The role demands a blend of analytical thinking and technical expertise, encompassing responsibilities such as diagnosing complex issues, crafting architectural solutions, designing MVPs, developing prototypes, and driving Agile-based software delivery. You’ll ensure quality, security, and performance are embedded throughout the development lifecycle. As a strategic contributor and innovation driver, you’ll play a central role in exploring emerging technologies and validating new approaches through proofs of concept.<ul><li>Analyze objectives and goals to identify common patterns, leverage points and consistent business needs across multiple business units and initiatives. Develop reference architectures and models for the major architectural domains: business, information, technical, and system architectures. Define architectural evolution and roadmaps for major products that align with the reference architectures. Ensure all designs and architecture align to IT security best practices and compliance standards (e.g., SOC2, HiTRUST, HIPAA).</li></ul><ul><li>Analyze business strategy to define and develop solutions that enable their successful execution. Break down the business objectives and strategies into technical initiatives spanning multiple programs, projects, products, and releases.</li></ul><ul><li>Serve as expert level advisor to business and IT management on architectural and technology topics, best practices, risks and opportunities.</li></ul><ul><li>Oversee security architecture and infrastructure to ensure solutions are inline and supportive of Synergie’s security posture and best practices. Follow good documentation practices including producing and managing formal artifacts, as well as writing clean, readable, and standards-compliant architectural artifacts.</li></ul><ul><li>Provide clear direction, coaching and support to business and technical staff on various teams. Recommend, define, and establish cross functional organizational structures that facilitate the successful achievement of architectural consistency and business alignment.</li></ul><ul><li>Review and approve architectural documents</li></ul>Education, Experience, and CertificationPreferred:Bachelor's or Master's Degree or equivalent experience.Experience:Required:Minimum 10 years of IT or software development work experience including enterprise architecture, software and system architecture, business analysis and business process architecture, application system design and implementation, technical team leadership.Knowledge, Skills, and Abilities<ul><li>In-depth knowledge of state-of-the-art programming languages and object-oriented approaches in designing, coding, testing and debugging programs</li><li>Deep understanding of cloud architecture principles, particularly in AWS ecosystems (e.g., Lambda, Glue, S3, Step Functions, RDS)</li><li>Expertise in modern data architectures, including data pipelines, ETL processes, and real-time data processing</li></ul><ul><li>Extensive use of Project Management methodologies</li></ul><ul><li>Expert level understanding of the health insurance industry preferred</li></ul><ul><li>Advanced analytical and conceptual skills</li></ul><ul><li>Ability to create original concepts/theories for various projects</li><li>Strong hands-on development skills in at least one language (e.g., Python, JavaScript, or Java)</li></ul><ul><li>Advanced leadership skills</li></ul><ul><li>Ability to perform cost benefit analysis, business case development, and financial justification</li></ul><ul><li>Excellent presentation and communication skills</li></ul><ul><li>Understands and consistently applies the attributes and processes of current application development methodologies</li></ul><ul><li>Strong research skills in emerging technologies and possible application to the business</li></ul><ul><li>Ability to maintain key relationships to achieve business objectives</li><li>Effective communication and stakeholder engagement across technical and non-technical audiences</li><li>Navigate ambiguity and drive alignment in cross-functional, fast-paced environments</li><li>Anticipate future technology needs and architect flexible, future-proof systems</li></ul>Financial ResponsibilitiesRevenue Responsibility:NoBudget Responsibility: Yes - financial business case justification and performing cost-benefit analysis.People Management: Varies#LI-Remote

Senior Solutions Architect

The hiring range for this role is: &nbsp;92,787.88 - 139,616.25This is the lowest to highest salary we, in good faith, believe we would pay for this role at the time of this posting.&nbsp; We may ultimately pay more or less than the hiring range andthis hiringrange may also be modified in the future. A candidate’s position within the hiring range may be based on several factors including, but not limited to, specific competencies, relevant education, qualifications, certifications, relevant experience, skills, seniority, performance, shift, travel requirements, and business or organizational needs.&nbsp;This job is also eligible for annual bonusincentivepay.We offer a comprehensive package of benefits including paid time off, 11 holidays, medical/dental/vision insurance, generous 401(k) matching, lifestyle spending account and many other benefits to eligible employees.Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.Job Description Summary: This role is responsible for leading and managing small to mid-size projects and portions of larger projects addressing critical strategic issues for the Blue System. The role is responsible for applying analytical rigor (e.g., data collection and analysis) and executing primary and secondary research, including BCBS Plan input. The position will be able to identify actionable insights and share with non-technical audiences, including senior leadership. The role requires attention to detail, collaboration and project management. He/she/they will communicate up, down and around to keep business partners engaged and motivated to act on strategic insights.Responsibilities include but are not limited to:<ul><li>Develop executive deliverables and present findings to inform and influence key decision makers. 30%</li><li>Conduct primary/secondary research, synthesize findings, and identify strategic recommendations. 25%</li><li>Project lead for mid-size projects and portions of larger projects 25%</li><li>Support strategic planning including BCBS Plan engagement. 15%</li><li>Provide coaching and oversight to junior staff 5%</li></ul>Required Education, Certifications and Experience:Education:<ul><li>Preferred Bachelor's Degree in related discipline; or equivalent work experience</li></ul>Experience:<ul><li>5+ Years related business experience Required</li></ul>Knowledge Skills and Abilities:<ul><li>Experienced analytical and creative problem-solving skills to lead hypothesis development and integration.</li><li>Competency to generate actionable insights from analytical work.</li><li>Effective written and verbal communication skills, including facilitation and presentation abilities.</li><li>Demonstrated ability to work independently.</li><li>Familiarity with health insurance industry and concepts.</li><li>Proficient relationship building and influence skills.</li><li>Mentoring skills: ability to mentor junior staff and aid in career development.</li></ul>Additional information:<ul><li>A minimum of 5 years related business experience</li><li>Experience with business/product strategy development and application of analytical methods</li><li>Strong project lead experience in preparing work plans leading small to mid-sized projects and portions of larger projects</li></ul>#LI_HYBRID

Corporate Strategy Senior Consultant

The hiring range for this role is: &nbsp;128,659.47 - 198,256.42This is the lowest to highest salary we, in good faith, believe we would pay for this role at the time of this posting.&nbsp; We may ultimately pay more or less than the hiring range andthis hiringrange may also be modified in the future. A candidate’s position within the hiring range may be based on several factors including, but not limited to, specific competencies, relevant education, qualifications, certifications, relevant experience, skills, seniority, performance, shift, travel requirements, and business or organizational needs.&nbsp;This job is also eligible for annual bonusincentivepay.We offer a comprehensive package of benefits including paid time off, 11 holidays, medical/dental/vision insurance, generous 401(k) matching, lifestyle spending account and many other benefits to eligible employees.Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.Job Description Summary: This position will work to achieve the State Affairs team's advocacy and Plan support objectives. Executes strategies that advance BCBSA's legislative and regulatory objectives, advocating for BCBSA's policy priorities. Develops and maintains productive relationships with assigned national organizations of state officials' and other key stakeholders. Represents BCBSA and the Blue System at state-based officials' meetings, events, and related conferences. Works collaboratively across the broader Association, and with the Plans to inform and execute strategies for issues impacting Plan business while staying current on the range of health policy issues that directly impact the insurance industry.Responsibilities include but are not limited to:<ul><li>Relationship Building: Develops and strengthens relationships with national organizations of state officials and related groups to monitor and influence legislative and regulatory developments. 30%</li><li>Representation and Advocacy: Represents BCBSA at state-based meetings and events, providing summaries to inform strategies, and advocates for BCBSA and Plan positions. 30%</li><li>Monitoring and Strategy Execution: Monitors state activities impacting Plan business, collaborates with Plans to develop and execute advocacy strategies, and leads state health policy projects. 15%</li><li>Strategic Insight and Collaboration: Provides political insights on policy priorities, engages in interdepartmental groups, supports coalitions, and collaborates across External Affairs to build BCBSA positions. 15%</li><li>Independent and Creative Action: Works with State Affairs leadership to develop strategic objectives, uses contacts to keep staff informed of developments, and leverages information to formulate strategies. 5%</li><li>Comprehensive Understanding: Maintains a thorough understanding of Plan business interests, policy goals, and assesses legislative impacts. 5%</li></ul>Required Education, Certifications and Experience:Education:<ul><li>Preferred Bachelor's Degree or equivalent work experience</li></ul>Experience:<ul><li>7+ Years experience working in State Government, State Officials organizations or government affairs experience communicating policy views and knowledge of State government environment Required</li></ul>Knowledge Skills and Abilities:<ul><li>Strong understanding of the health care industry and the State legislative and regulatory environment, including health insurance issues and legislative policy developments</li><li>Demonstrated proficiency with database, legislative tracking and research programs, and other information tracking software Working knowledge of state level grass roots organizing and/or coalition development, a plus</li><li>Ability to synthesize complex problems and public policy issues, identifying business implications and advocating for recommended outcomes Demonstrated ability to collaborate in groups and be a team player, with knowledge of state government processes and procedures</li><li>Strong analytical and strategic thinking skills to influence decision/policy makers Ability to influence, negotiate, and persuade others, demonstrating strong judgment, decision-making skills, and political acumen</li><li>Strong organizational, verbal, and written communication skills, with project management, analytical, planning, and presentation abilities, and the ability to build and sustain effective relationships.</li><li>Proficiency with Microsoft Office, PowerPoint, Teams</li><li>Experience working in State Government, State Officials organizations or government affairs. Experience communicating policy views and knowledge of State government environment.</li><li>Experience working in state government on health or insurance related issues. Experience working with National Organizations of State Officials (NGA, NCSL, NAAG, NASHP) and political groups (RGA/DGA, DAGA/RAGA, RLCC/DLCC)</li></ul>#LI_HYBRID

16 Blue Cross Blue Shield Association Jobs