Your Role. The Pharmacy Prior Authorization team provides efficient and accurate responses to external customers (physicians, office staff, pharmacy providers, members, and brokers) and internal team members for all outpatient pharmacy benefit inquires. The Pharmacy Technician, Intermediate will report to the Supervisor, Pharmacy Services Operations. In this role you will resolve outpatient pharmacy benefit coverage inquiries, including prescript...
Job Description. The Senior Director, Chief of Staff to the CEO is a strategic leadership role responsible for driving enterprise-wide priorities, ensuring operational excellence, and enabling the CEO’s vision across the organization. Serving as a trusted advisor, the Chief of Staff leads cross-functional initiatives, manages Board and executive communications, and facilitates decision-making processes to advance corporate objectives. This role i...
Your Role. The Data Services and Solutions team is responsible for the technical design and end-to-end delivery of complex, data-driven solutions and products across the enterprise. We are looking for a seasoned professional who brings a strong combination of deep technical expertise and product ownership, with proven experience in delivering complex data solutions. This position reports to the Sr. Manager, Data Services and Solutions and will pa...
Your Role. The Application Services team plays a critical role in enhancing customer satisfaction and technical collaboration while delivering all application development through a Platform and Technology Product Operating Model. The Full Stack Engineer role will report to the Director, IT Applications (Integration and Interoperability Platform). In this role you will be deeply involved in the design, development, and deployment of secure, high-q...
Job Description. Your Role. The End-to-End Member Experience Transformation and Health Plan Correspondence Output Management team is positioned to radically improve how we communicate with customers, aligning with our mission to make complex healthcare simple. The Administrative Assistant, Advance will report to the Senior Director, and support other peer Directors. In this role you will provide high-level administrative support to Directors / Se...
Your Role. The Appeals and Grievances team receives, documents, investigates, refers, and coordinates grievances, appeals and complaints. The Clerical Support, Entry position will report to the Operations, Supervisor. In this role, the office clerk will be responsible for performing a variety of administrative tasks for the team such as filing documents and managing correspondence to ensure the smooth operation of the office. They also support st...
Your Role. The Product Strategy Insights Analytics team supports the Product Strategy and marketing team with analytical and financial modeling for product development activities for Blue Shield of California. The Senior Principal analyst will report to the Senior manager, Insights. The team provides valuable insights to strategists to devises strategies and supports work to make healthcare affordable through data analysis, cost of healthcare mod...
Job Description. Your Role. The Global Business Services team sources for all vendors and goods needed for Blue Shield of California and other entities under the Ascendiun holding company umbrella. This role oversees all IT procurement and sourcing for the health plan, and Ascendiun's subsidiary, Stellarus IT. The Senior Director will be a key member of the Procurement Management team, responsible for providing leadership, guidance, and structure...
Job Description. Your Role. Reporting to the Sr. Director, the Planning, Performance, and Enablement Customer Service plays a pivotal role in advancing the goals of Blue Shield of California and the Customer Experience department. As a key member of the Customer Service leadership team, this individual will lead and collaborate across our Share Markets operations — including subset of operational work for Government and Commercial areas that incl...
Job Description. Your Role. The ITS Host Claims team processes claims and adjustments for out of state Blue Cross Blue Shield members that have services in California in a shared adjudication process. The Claims Processor Intermediate will report to the Operations Supervisor. In this role you will be responsible for reviewing and adjudicating claims and/or adjustments in accordance with provider contracts and organizational policies and procedure...
Job Description. Your Role. The ITS Host Claims team processes claims and adjustments for out of state Blue Cross Blue Shield members that have services in California in a shared adjudication process. The Claims Processor Intermediate will report to the Operations Supervisor. In this role you will be responsible for reviewing and adjudicating claims and/or adjustments in accordance with provider contracts and organizational policies and procedure...
Your Role. The Quality Review team completes audits of front-line staff to ensure alignment with department processes and regulatory compliance. Clinical Quality Auditors also provide coaching and work closely with business leaders to drive optimal results. The Clinical Quality Auditor, Consultant will report to the Quality Review Senior Manager. In this role you will develop performance metrics, evaluate performance, and provide coaching to ensu...
