CareFirst BlueCross BlueShield
Resp & Qualifications PURPOSE: Responsible for answering member, provider & broker inquiries pertaining to product information, benefits, claims resolution, eligibility and billing questions in a call center environment. Proactively provides information and education to members, providers & brokers, as appropriate,…
Resp & Qualifications PURPOSE: The Pharmacy Supply Chain Director is responsible for leading critical financial and analytic functions within the Pharmacy Management department. This role ensures the organization maximizes contractual value by overseeing reconciliation of pharmacy rebates and network discounts…
Resp & Qualifications PURPOSE: Director, Pharmacy Services is responsible for implementing the organization's pharmacy vision and strategic plan for government programs including Maryland Medicaid, Dual Prime Special Needs Plan (DSNP), and Medicare Advantage products. This role has oversight of pharmacy…
Resp & Qualifications PURPOSE: Develops and Implements strategy for the Experience and Digital Marketing product line and is responsible for the product planning and execution throughout the Product Lifecycle, including gathering and prioritizing product and customer requirements, defining the product…
Resp & Qualifications PURPOSE: This position will support the modernization and redesign of the utilization management department. Utilizes data analytics and supports a set of business initiatives designed to help extract value from information. Develops data visualizations for analysis, problem…
Resp & Qualifications PURPOSE: Supervise and provides daily direction to multi functional team members regarding training and development, policies, procedures, and work production quantity and quality. Functional areas may include but not limited to: installation, implementation, client support, client services,…
Resp & Qualifications CANDIDATES MUST BE LOCAL TO MD, DC, VA PURPOSE: The Clinical Advisor's role is multifaceted, involving data analytics, client facing presentations, and solutions optimization. The Clinical Advisor will extract relevant clinical data and educate clients, brokers, consultants,…
Resp & Qualifications PURPOSE: The role of the Nurse, Quality Review Utilization Management (UM) is to evaluate clinical quality and procedures within the Utilization Management (UM) program to maximize efficiency, ensure compliance and optimize patient care and safety. This position…
Resp & Qualifications PURPOSE: Responsible for leading the planning, execution, and continuous improvement of quality initiatives within the IT organization, with a primary focus on managing the rollout and adoption of a formal quality framework (such as ISO 9001 or…
Resp & Qualifications PURPOSE: The Lead Business Analyst will have the responsibility to ensure that the business's need for changes to processes, policies and/or information systems are identified, understood, defined, documented and acted upon by eliciting, analyzing, documenting, validating, specifying…
Resp & Qualifications PURPOSE: Drives enterprise optimization by introducing capabilities (inclusive of all functions) for their domain of responsibility utilizing in depth knowledge and expert skills to advance domain strategies. Translates business needs for the domain into architectural solutions that…
Resp & Qualifications PURPOSE: The Payment Integrity Analyst is responsible for conducting research and analysis and reviewing billing requirements, provider manuals, medical policies, and other sources as needed to identify new overpayment concepts, as well as validate all prospective and…
Resp & Qualifications PURPOSE: This position will manage all key aspects of systems operations, including configuration setup, system and integration testing, production issues triage and resolution, and interface monitoring/ resolution. The position will also support the operations team in defining…
Resp & Qualifications PURPOSE: Investigate and perform adjustment of claims and ensure that claims are handled properly within authority limits, and in line with standard procedures and guidelines. Verifies insurance claims by reviewing claims requirements; examining documentation and calculations; highlighting…
Resp & Qualifications We are looking for an experienced professional in the greater Baltimore/Washington metropolitan area who is willing and able to work in a hybrid model. The incumbent will be expected to work a portion of their week from…
Resp & Qualifications PURPOSE: Optimizes Operations results by identifying and analyzing business requirements and operations; conducting performance studies; identifying key business metrics; developing and calibrating analytical, recommending process improvement priorities; identifying low cost designs, materials, processes, and sources; evaluating new…
Resp & Qualifications PURPOSE: We are looking for an experienced Care Manager to support our Maryland Medicare enrollees. Under minimal supervision, the Care Manager researches and analyzes a member's medical and behavioral health needs and healthcare cost drivers. The Care…
Resp & Qualifications PURPOSE: Acts as an internal expert to ensure that as value based reimbursement and medical policy models are developed and implemented. Provides advanced knowledge to support effective partnership with provider entities and guidance on the appropriate quality…
Resp & Qualifications We are looking for an experienced professional in the greater Baltimore/Washington metropolitan area who is willing and able to work in a hybrid model. The incumbent will be expected to work a portion of their week from…
Resp & Qualifications We are looking for an experienced professional in the greater Baltimore/Washington metropolitan area who is willing and able to work in a hybrid model. The incumbent will be expected to work a portion of their week from…
Resp & Qualifications CANDIDATES MUST LIVE IN THE MD, DC, NORTHEN VA AREA IN ORDER TO TRAVEL INTO THE OFFICES AND FOR CLIENT MEETINGS AND STAFF MEETINGS. PURPOSE Manages and supports the sales growth and retention of assigned Account Consultants…
Resp & Qualifications Candidates must live in the MD, DC, Northern VA area in order to travel into the offices occasionally. PURPOSE: The Broker Support Representative II serves as the primary liaison between our organization and key health insurance broker…
Resp & Qualifications CANDIDATES MUST LIVE IN THE MD, DC, NORTHEN VA AREA IN ORDER TO TRAVEL INTO THE OFFICES AND FOR CLIENT MEETINGS AND STAFF MEETINGS. PURPOSE: As a key member of our Account Management Team, the Account Manager…
Resp & Qualifications CANDIDATES MUST LIVE IN THE MD, DC, NORTHERN VA AREA IN ORDER TO TRAVEL INTO THE OFFICES AND FOR CLIENT MEETINGS AND STAFF MEETINGS. PURPOSE: This position is responsible for renewing/growing a book business which includes more…
Resp & Qualifications PURPOSE: The Specialist, Quality Assurance I is responsible for examining and evaluating the accuracy of transactions in accordance with regulations and company guidelines. Fairly and consistently reviews team interactions with both internal and external parties to ensure…
Resp & Qualifications CANDIDATES MUST LIVE IN THE MD, DC, NORTHERN VA AREA IN ORDER TO TRAVEL INTO THE OFFICES AND FOR CLIENT MEETINGS AND STAFF MEETINGS. PURPOSE: This position is responsible for renewing/growing a book business which includes more…
Resp & Qualifications PURPOSE: Serves as an authority over Product Owners and product teams to ensure clarity in strategic direction. Brings an expertise to lead and manage project requirements and introduces new, beneficial tools and practices. Focuses on managing the…
Resp & Qualifications PURPOSE: Serves as an authority over Product Owners and product teams to ensure clarity in strategic direction. Brings an expertise to lead and manage project requirements and introduces new, beneficial tools and practices. Focuses on managing the…
Resp & Qualifications PURPOSE: Serves as an authority over Product Owners and product teams to ensure clarity in strategic direction. Brings an expertise to lead and manage project requirements and introduces new, beneficial tools and practices. Focuses on managing the…
Resp & Qualifications Candidates must live in the MD, DC, Northern VA area in order to travel into the offices occasionally. PURPOSE: The Broker Support Representative II serves as the primary liaison between our organization and key health insurance broker…
Resp & Qualifications CANDIDATES MUST LIVE IN THE MD, DC, NORTHERN VA AREA IN ORDER TO TRAVEL INTO THE OFFICES AND FOR CLIENT MEETINGS AND STAFF MEETINGS. PURPOSE: This position is responsible for renewing/growing a book business which includes more…
Resp & Qualifications Candidates must live in the MD, DC, Northern VA area in order to travel into the offices occasionally. PURPOSE: The Broker Support Representative II serves as the primary liaison between our organization and key health insurance broker…
Resp & Qualifications PURPOSE: Configures, tests and documents configuration solutions for provider reimbursement configuration set up and maintenance, benefit package configuration setup and maintenance, membership configuration set up and maintenance, setup of code sets used for configuration in benefits &…
Resp & Qualifications PURPOSE: Serves as a senior authority over Product Owners and product teams, ensuring strategic alignment and clarity. Leverages extensive expertise to lead and manage complex project requirements, introducing innovative tools and best practices. Oversee the development of…
Resp & Qualifications PURPOSE: Develops and Implements strategy for the company's product line and is responsible for the product planning and execution throughout the Product Lifecycle, including gathering and prioritizing product and customer requirements, defining the product vision. Working with…
Resp & Qualifications PURPOSE: This role provides relevant new hire and supportive ongoing training/professional development which create and maintain a motivated, skilled and effective team through which organizational goals are achieved. ESSENTIAL FUNCTIONS: Designs, develops and/or facilitates instructor led training…
Resp & Qualifications PURPOSE: This position supports the Inpatient Management clinical teams by handling non clinical tasks related to preauthorization functions, inpatient care, utilization review, care coordination and/or quality of care, enabling clinical staff to perform at the top of…
Resp & Qualifications PURPOSE: The Appeals Specialist I is responsible for the initial analysis of appeals and/or grievance correspondence, and determination of next steps for Commercial and FEP lines of business. Responsible for collecting, organizing and tracking information to facilitate…
Resp & Qualifications PURPOSE: The Appeals Specialist I is responsible for the initial analysis of appeals and/or grievance correspondence, and determination of next steps for Commercial lines of business. Responsible for collecting, organizing and tracking information to facilitate and expedite…
Resp & Qualifications PURPOSE: The Appeals Specialist I is responsible for the initial analysis of appeals and/or grievance correspondence, and determination of next steps for Commercial lines of business. Responsible for collecting, organizing and tracking information to facilitate and expedite…
Resp & Qualifications PURPOSE: The Appeals Specialist I is responsible for the initial analysis of appeals and/or grievance correspondence, and determination of next steps for Commercial lines of business. Responsible for collecting, organizing and tracking information to facilitate and expedite…
Resp & Qualifications PURPOSE: The Appeals Specialist I is responsible for the initial analysis of appeals and/or grievance correspondence, and determination of next steps for Commercial and FEP lines of business. Responsible for collecting, organizing and tracking information to facilitate…
Resp & Qualifications PURPOSE: The Appeals Specialist I is responsible for the initial analysis of appeals and/or grievance correspondence, and determination of next steps for Commercial and FEP lines of business. Responsible for collecting, organizing and tracking information to facilitate…
Resp & Qualifications Although this position is REMOTE, candidates must live in the MD/DC/VA area in order to travel as needed to the nearest CareFirst Office. PURPOSE: Responsible for answering member, provider & broker inquiries pertaining to product information, benefits,…