Our Customer Experience Teams receive incoming telephone calls from our members. Our Call Centers are open 7 days a week. If hired, you will be required to attend and complete a paid, mandatory training. Training will be held in a remote environment. Remote training requires secure, reliable internet connectivity. Any hybrid work or training requires both remote and on pr

Your Role The Medi Cal Program Support (MPS) team ensures sufficient and complete Medi Cal operational documentation by reviewing and supporting development of business process documentation; development of regulatory data and files process documentation; and development of employee trainings. The Business Analyst will report to the Senior Manager of the Business Process

Your Role The Special Investigations Unit team is responsible for preventing, detecting, investigating, and resolving health care fraud, waste, and abuse . The Special Investigations Investigator, Consultant will report to the SIU Manager. In this role you will represent a high level of professionalism both internally and externally. Conduct investigations in accordance w

Your Work In this role, you will Be responsible for analytic work required to convert pricing and financial goals at the line of business and region level into specific action plans at the provider level that the Network team can execute Build and update models that allow the actuarial team to quantify financial gaps and opportunities at a provider level Conduct and devel

Your Work In this role, you will Be responsible for converting pricing and financial goals at the line of business and region level into specific action plans at the provider level that the Network team can execute Create value for the Growth team General Managers by ensuring they have a voice when it comes to key network decisions and network strategy Create value for th

Your Role The Network Performance Analysis and Contracts is part of the Provider Partnerships & Network Management Division and focuses on provider network performance analysis, reporting, and consulting. The Data Analyst Health, Experienced will report to the Manager, Data Analysis. In this role you will provide analytical support through the analysis and interpretation

Your Role The Claims Shared Support Services team actively engages in providing and eliciting business requirements for system enhancements, by identifying a desired future state that addresses a business problem utilizing multiple analytic methods e.g. interviewing, brainstorming, chair siding/observation, problem identification, and gap analysis. The Business Systems An

Your Role The Federal Employee Program (FEP) team performs integrated case management (CM) and disease management (DM) activities demonstrating clinical judgment and independent analysis, collaborating with members and those involved with members' care including clinical nurses and treating physicians . The Behavioral Health Registered Nurse Case Manager will report to th

Your Role The Enterprise Finance Consolidations and Business System team is responsible for the Company's consolidated financial statements, forecasting and reporting activities, business systems and administrative expense allocations. The team manages financial forecast and annual planning activities, provide monthly, quarterly, and annual consolidated financial reportin

Your Role The Medical Care Solutions Clinical Service Intake team responsible for timely and accurate processing of Treatment Authorization Request. The Clinical Services Coordinator will report to the Supervisor of Clinical Services Intake. In this role you will be for supporting clinical staff day to day operations for Promise lines of business. Your Work In this role,

Your Role The ACA Chart Program team conducts the following functions (1) identify medical records with unreported diagnosis codes, (2) retrieve those medical charts, (3) perform medical coding to convert them into risk adjustable diagnosis codes, and (4) submit to CMS via the EDGE pathway . The Risk Adjustment, Consultant will report to the Senior Manager . In this role

Your Role The Customer Experience, Digital, and Operations Analytics team is responsible for accelerating data driven value based solutions that drive out expense, generate growth while elevating experience for members, providers and brokers. The Senior Manager of Digital and Marketing Analytics will report to the Senior Director of Customer Experience, Digital, and Opera

Your Role The Senior level Developer of the Client Personalization team is responsible for application service level achievement and customer satisfaction of Blue Shield of California's Salesforce Health Cloud capabilities. This developer creates, configures, and manages Salesforce applications and related components and will be accountable for delivering BSC's desired bu

Your Role The Corporate Services Finance team ensures financial stewardship of the Corporate Services administrative budget and serves as the trusted financial advisor to executive leadership. Our team is looking for a Financial Analyst, Consultant to steer financial performance toward Blue Shield goals. The position will support annual planning, monthly forecasting, mont

Your Role The Developer and Employee Experience team is responsible for creation of the standard and automation pipelines that enable our partnering IT teams to build, release, and manage their systems. We are setting the path for how we'll migrate to the Cloud and ensure that we are guiding the movement to a more modern DevOps operating model. The Sr. Principal Enterpris