Executes measures for the prevention, identification and investigation of fraud, waste, and abuse (FWA) perpetrated against the Federal Employee Program (FEP). Ensures that Blue Cross Blue Shield (BCBS) Plans and Pharmacy Benefit Managers (PBMs) meet reporting requirements as mandated by the Carrier Letter and FEP Special Investigations Unit (FEP SIU) Standards Manual. Pro

The Executive Director supports strategic and operational leadership of the BCBSA Clinical Team, including support of the creation of the clinical operations strategy and delivery of value added resources and tools. This role provides clinical expertise and population health thought leadership in support of delivering more affordable and quality care for all members. In ad

Provides oversight and management of all drug utilization and spend across both the Pharmacy and Medical drug benefit. Provides operational oversight and management of the FEP Employer Group Waiver Plan program and Medicare Part D business. Works with contracted PBM's, executives, and operational staff on ongoing contract administration and maintenance. Leads the dire

Job Description Summary The Director, Systemwide Cybersecurity and Compliance will manage key aspects of implementing our Systemwide Cyber Strategy and governance across 33 Plans and several Non Plan Entities that represent the Blue Cross Blue Shield System. The Director will also provide thought leadership and support to Management in their work with Systemwide CISOs and

Job Description Summary The Senior Consultant, Customer Experience, is responsible for contributing to the Brand Strategy team and Corporate Affairs more broadly with various projects related to membership retention and growth to support the health of the Blue Cross Blue Shield Brand. Responsibilities include managing both internal and external initiatives and partnering w

Job Description Summary Responsible for the design, development and implementation of advanced technology systems and data standards to meet the needs of business. Partners with customers to understand business requirements to create the technical functional specifications. Acts as an internal data consultant to advise and influence business and technical partners. This ro

The Senior Consultant Internal Audit plans and leads audits of BCBSA operational, financial, governance, risk management and compliance processes. Audits are performed across all business units to identify risks and evaluate internal controls according to BCBSA and professional standards. Specific areas of focus include control design, operation and efficiency, policy comp

Job Description Summary The Principal Cloud Architect will lead the engineering and operational strategy for cloud architecture, focusing on AWS cloud native and hybrid cloud data solutions, analytics, and AI/ML applications for our Blue Systems of Intelligence (BSI) cloud native data platform. Key Responsibilities Serve as the technical lead of the BSI Platform Operations

Provides strategic leadership for all current FEP member facing products (Medical, Dental and Vision, Postal and Overseas) as well as future portfolio expansion to meet enrollment goals and profitability targets. Works collaboratively with Actuarial team to develop the strategy for product pricing, and competitive scenarios to manage portfolio stability. Responsible for wo

Develops, implements and administers Federal Employee Program (FEP) financial policies to ensure FEP compliance with the requirements of the Federal Acquisition Regulation, the Federal Employee Health Benefit Acquisition Regulation, the applicable Cost Accounting Standards, the Financial Accounting Standards, and the terms of the FEP contract, C.S. 1039, as well as to ensu

Job Description Summary The Manager, Customer Experience Research and Design, is responsible for leading and contributing to the Brand Strategy team and Corporate Affairs more broadly with various projects related to membership retention and growth to support the health of the Blue Cross Blue Shield Brand. Responsibilities include managing both internal and external initia

Job Description Summary Are you passionate about cyber risk management? Are you someone who enjoys creating new and collaborative processes? Do you enjoy helping others succeed by leading in risk based decision making discussions? We have an opportunity for you at BCBSA Information Security. We are looking for a cyber risk management leader (Director level role) to lead th

Lead federal and regulatory national health information technology and interoperability strategy for BCBSA by developing federal policy positions and federal outreach activities to ensure BCBSA is able to effectively influence the development and implementation of a nationwide, interoperable health care system. Position will be highly visible within BCBSA and externally to

Senior leader to advance BCBSA's legislative and regulatory policy solutions and market positioning in Medicare, Medicaid, Duals, and Children's Health Insurance Program, impacting the tens of millions of Americans we cover, serve, and support in these programs. This role will be a critical policy voice on the most pressing policy issues, serving as a lead advocate for gov

Responsible to BCBS Plan and other key stakeholders to provide clinical expertise and leadership for medical affairs strategy development and implementation. Serves as a thought and opinion leader to provide clinical leadership and support to internal and external strategic initiatives in support of BCBSA and BCBS Plans. Works collaboratively with other medical directors t