Blue Cross Blue Shield of Michigan jobs - 51 jobs

Senior Internal Auditor
Blue Cross Blue Shield of Michigan 4.8
Blue Cross Blue Shield of Michigan job in Boston, MA or remote
Ready to help us transform healthcare? Bring your true colors to blue. As a valued member of the Audit and Risk Management (ARM) team, the Senior Internal Auditor will lead and execute a variety of financial, operational, and risk-based audits as well as advisory and consulting engagements. This role is a key contributor to the organization, providing critical assurance that risks are being managed effectively. The ideal candidate will be a proactive and analytical professional who thrives in a collaborative, cross-functional environment. This position offers significant exposure to diverse areas of the company and direct interaction with key stakeholders. Further, this role will be asked to use data analytics tools and techniques to enhance audit testing, identify emerging risks, and drive automation and efficiency in audit processes. This role is eligible for our Flex persona What you'll do: Conduct or support Model Audit Rule (MAR) and other audits, in compliance with established policies, plans, procedures and governmental regulations to ensure effectiveness of financial and operational controls. May also perform related IT control test-work or participate in projects for other Internal Audit teams as needed. Provide support for key financial and operational areas impacting financial reporting and risk-based audits of these areas (e.g. Enrollment, Premiums, Claims Operations, Provider Enrollment and Pricing, Accounting, and Information Technology areas). Drive value-add advisory and consulting engagement as needed. Suggest and execute ideas for enhancing operational efficiency, in alignment with the Company's commitment to quality assurance and continuous improvement methodology, including the use of automation and analytics. Assist in developing control consciousness in the business units audited. Assist with or coordinate regulatory, compliance, or operational readiness assessments. Provide ongoing communication regarding audit status and findings to audit leadership and business area management. Identify and communicate areas of risk and communicates those risks effectively to Internal Audit management. Conduct regular follow up with business leads to ensure that outstanding items are resolved. Assist in preparing audit communications, reports and supporting documentation related to findings and value-added recommendations that promote effective and efficient solutions to business issues and risks. Support multiple, concurrent projects with extremely tight deadlines, reporting to different project team leaders. We're looking for: The ability to work independently on complex projects and as part of a project team. Effective time management skills, including the ability to handle multiple project assignments and deadlines simultaneously and track/monitor project issues. The ability to identify risks and formulate proposed action steps to be discussed with Internal Audit management. Someone who develops positive relationships with peers, leaders, and external parties to influence positive outcomes and ensure resolution of audit issues. Effective written and verbal communication skills. Strong analytical and problem-solving skills. What you bring: Bachelor's degree in Accounting, Business, or related field is required; graduate degree is a plus. 2-4 years of internal audit experience is required within finance and/or operations; experience in public accounting or a healthcare background preferred but not required. Experience with data visualization tools (Tableau, Power BI, others), SQL, and/or SAS programming language for data extraction and manipulation. Certifications in Internal Auditing (CIA) and auditing Information Systems (CISA) is preferred. CPA, or candidate working toward CPA designation, is preferred but not required. Working knowledge of/experience with general internal control requirements, and general understanding of business operations, financial and information technology procedures, and controls. Excellent oral and written communication skills, effective report writing and presentations. Project management skills with demonstrated experience in meeting project timelines and deliverables and the ability to handle multiple project assignments simultaneously. Demonstrated ability to work independently and as part of a project team Proficient with Microsoft Office applications including Word, Excel, Access, Power Point, and Visio. Experience with AuditBoard and/or ACL is a plus. What you'll gain: Perks of the job include a healthy work-life balance (37.5 weekly hours), significant autonomy, flexibility in remote work arrangements, competitive benefits, and a culture of learning and development. This role provides a unique vantage-point to understanding the entire organization and an opportunity to make a tangible impact on its success. We are embarking on a journey to discover ways in which automation can influence our work, and this role will play a key part in identifying those opportunities. Minimum Education Requirements: High school degree or equivalent required unless otherwise noted above LocationBoston, HinghamTime TypeFull time Salary Range: $87,390.00 - $106,810.00 The job posting range is the lowest to highest salary we in good faith believe we would pay for this role at the time of this posting. We may ultimately pay more or less than the posted range, and the range may be modified in the future. An employee's pay position within the salary range will be based on several factors including, but limited to, relevant education, qualifications, certifications, experience, skills, performance, shift, travel requirements, sales or revenue-based metrics, and business or organizational needs and affordability. This job is also eligible for variable pay. We offer comprehensive package of benefits including paid time off, medical/dental/vision insurance, 401(k), and a suite of well-being 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. WHY Blue Cross Blue Shield of MA? We understand that the confidence gap and imposter syndrome can prevent amazing candidates coming our way, so please don't hesitate to apply. We'd love to hear from you. You might be just what we need for this role or possibly another one at Blue Cross Blue Shield of MA. The more voices we have represented and amplified in our business, the more we will all thrive, contribute, and be brilliant. We encourage you to bring us your true colors, , your perspectives, and your experiences. It's in our differences that we will remain relentless in our pursuit to transform healthcare for ALL. As an employer, we are committed to investing in your development and providing the necessary resources to enable your success. Learn how we are dedicated to creating an inclusive and rewarding workplace that promotes excellence and provides opportunities for employees to forge their unique career path by visiting our Company Culture page. If this sounds like something you'd like to be a part of, we'd love to hear from you. You can also join our Talent Community to stay “in the know” on all things Blue. At Blue Cross Blue Shield of Massachusetts, we believe in wellness and that work/life balance is a key part of associate wellbeing. For more information on how we work and support that work/life balance visit our "How We Work" Page.
$87.4k-106.8k yearly Auto-Apply 16d ago

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Specialty Insurance - Senior Program Manager (AF Specialty)
Blue Cross Blue Shield of Michigan 4.8
Remote Blue Cross Blue Shield of Michigan job
Role provides oversight of property and casualty programs via a delegated underwriting authority model. Responsible for maintaining strong partnership with the MGAs/MGUs/ program administrators, delivering operational excellence, ensuring adherence to underwriting guidelines, and alignment with the overall business strategy. The Senior Program Manager will serve as the primary point of contact between the MGA/MGU/program administrator and internal stakeholders, driving collaboration, profitability, and growth across the business portfolio. The Senior Program Manager will also serve as a mentor and trainer for other program managers. ESSENTIAL DUTIES AND RESPONSIBILITIES Other duties may be assigned. Manage complex program performance and profitability by monitoring key performance indicators, creating action plans when needed, handling underwriting referrals, and driving improvements in challenged segments through coordination with program administrators. Lead product development for the complex programs by building and maintaining underwriting guidelines, forms lists, letters of authority, and standards and procedures for those exceptions outside of the guidelines. Perform annual underwriting audits for all assigned programs, prepare audit reports, and ensure compliance with all recommendations made in accordance with division standards for timeliness. Partnering with key support units, including Finance, Actuarial, Claims, Legal, Compliance, Reinsurance, and Corporate Underwriting to analyze issues, identify solutions, and drive execution on challenges faced by the company, program administrators, and customers. Manage assigned relationships with program administrators, including regular visits. Support data collection needed for reinsurance placements, data calls, filings, or any other projects or requests. Support the writing of new programs and develop product or service enhancements for existing programs. Monitor and update premium and profitability projections Negotiate commission structures with program administrators Mentor and train other program managers EDUCATION AND EXPERIENCE Relevant combination of education and experience may be considered in lieu of degree. Bachelor's degree in insurance, business or a related field is required. Advanced insurance certification preferred. Minimum ten years of Property and Casualty experience, preferably in an underwriting and/or product development role. Minimum at least five years of program management via delegated underwriting authority or program administrator experience. Experience working with form/rate development and filing functions for programs is desired Certification or progress toward certification is highly preferred and encouraged. Continuous learning, as defined by the Company's learning philosophy, is required. QUALIFICATIONS To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. OTHER SKILLS AND ABILITIES Proficient with analyzing complex business problems. Excellent analytical, organizational and problem-solving skills. Highly entrepreneurial - comfortable within a culture that is fast-paced and dynamic Strong intellectual curiosity and desire to help others solve problems. Capable of influencing program administrator decision-making. Strong knowledge in commercial property and casualty underwriting. Knowledge of activities, practices and terminology of the commercial property and casualty insurance industry and relevant legal and administrative procedures. Ability to negotiate and establish a personal rapport with opposing parties, and to resolve conflicts in a professional manner. Ability to analyze and interpret financial and management data. Thorough knowledge of budget preparation and financial management. Ability to develop and implement effective and efficient recommendations. Self-directed in achieving closure on deliverables. Collaborative and team oriented. Excellent verbal and written communication skills. Demonstrated drive, determination, and persistence to achieve annual revenue targets. Presentation skills and confidence to present division and product in one-on-one settings or to large gatherings. A commitment to total customer satisfaction. ADDITIONAL INFORMATION The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of personnel so classified. This does not constitute a contract for employment. WORKING CONDITIONS: Work is performed remote in a virtual home office with minimal hazards. Travel for team meetings, industry events or corporate functions. The qualifications listed above are intended to represent the minimum education, experience, skills, knowledge and ability levels associated with performing the duties and responsibilities contained in this job description. Pay Range - Actual compensation decision relies on the consideration of internal equity, candidate's skills and professional experience, geographic location, market, and other potential factors. It is not standard practice for an offer to be at or near the top of the range, and therefore a reasonable estimate for this role is between $121,500 and $230,700 (P4D). We are an Equal Opportunity Employer. We will not tolerate discrimination or harassment in any form. Candidates for the position stated above are hired on an "at will" basis. Nothing herein is intended to create a contract. #LI-TM1 #AFG
$121.5k-230.7k yearly Auto-Apply 28d ago
Client Services Representative - Mid Shift (11:00am - 8:00pm)
CFA Institute 4.7
Remote job
Are you energized by helping people solve real problems? Do you thrive on delivering exceptional service in a fast-paced, global environment? As a Client Services Representative (CSR) at CFA Institute, you will be on the front lines of our Global Contact Center, serving candidates, members, and prospective applicants from around the world. Your empathy, agility, and problem-solving skills will directly shape the experience of individuals pursuing one of the most respected credentials in finance. This mid-shift role (11am-8pm ET) offers a unique opportunity to support our global audience during high-demand hours while growing your career in a mission-driven organization. CSRs gain broad organizational knowledge-an excellent foundation for future advancement across CFA Institute. What You'll Do Serve as the first point of contact for global candidates and members, providing accurate, empathetic support across voice, chat, and written channels. Act as a brand ambassador, personalizing each interaction and striving for first-contact resolution. Troubleshoot technical, functional, and administrative issues related to CFA Institute portals, registrations, and vendor platforms. Handle sensitive information with professionalism and strict adherence to data-security protocols. Collaborate with colleagues in IT, Credentialing, Marketing, and other teams to drive continuous improvement. Maintain strong performance across customer satisfaction, productivity, quality assurance, and service metrics. Demonstrate cultural competency and inclusivity in every interaction with our global community. What You'll BringMinimum Qualifications Proven success delivering frontline customer service resolving real-time issues for a diverse customer base. Experience in a fast-paced contact center or office environment with phone- and email-based service. Strong organizational skills and the ability to manage multiple priorities independently. Excellent verbal and written communication skills with a professional, diplomatic tone. Detail-oriented, tech-savvy, and eager to learn new systems and tools. Fluency in English (additional languages a plus). Must reside within a commutable distance to Charlottesville, VA (required for in-office training and monthly hybrid workdays). Preferred Qualifications Experience with Salesforce Service Cloud or similar customer service/case management platforms. Why Join Us? Working at CFA Institute means being part of a global mission that advances the highest standards of ethics, education, and professional excellence in the investment profession. You'll enjoy: A culture that values empathy, learning, collaboration, and putting clients first. An environment where CSRs gain broad institutional understanding-an ideal foundation for career progression into roles across Operations, Credentialing, Member Services, IT partnerships, and more. At CFA Institute, we are committed to transparency and equity in our hiring process. In compliance with wage transparency laws in many of the jurisdictions in which we recruit, we provide the following information regarding compensation for this position: Expected salary range: $50,000-$55,000 annually Other benefits include eligibility for annual incentives, 12% retirement employer contribution, and competitive medical benefits. All salary ranges are subject to adjustment based on experience, education, and other factors relevant to the position. CFA Institute is an equal opportunity employer and encourages applications from all qualified individuals. #LI-ML1 #LI-HYBRID #LI-REMOTE About CFA Institute CFA Institute are the global leader in investment excellence and ethics. With nearly 200,000 charterholders across 160 markets, we drive professional growth, ethical behavior, and better markets. We care about our employees' well-being, offering industry-leading benefits like: Comprehensive health coverage for you and your family Generous leave and time off Competitive retirement plans Flexible work options Wellness, education, and support programs If you feel this opportunity could be the next step in your career, we encourage you to click “Apply” and complete our three-minute application. Be part of a team committed to putting investors first and growing economies. Follow us @CFAInstitute on LinkedIn and X. Important Message: Your application must clearly demonstrate how you meet the requirements as CFA Institute cannot make assumptions about your education, experience, or location. We thank all those who apply. Only those selected for further consideration will be contacted. We are an Equal Opportunity Employer. CFA Institute prohibits both discrimination and harassment with regard to all identifying characteristics: any individual employee, group of employees, or prospective employee on the basis of race, color, national origin, citizenship or immigration status, religion, creed or belief, age, marital or partnership status, marital or family status, care giver status, pregnancy and maternity, sexual and other reproductive health decisions, physical abilities/qualities, disability, sexual orientation, gender, gender identity or expression, predisposing genetic characteristic, military or veteran status, status as a victim or witness of domestic violence or sex offense or stalking, unemployment status, infectious disease carrier status, migrant worker status, educational background, socio-economic status, geographic location and culture or any other basis protected by applicable law. This policy impacts all aspects of employment, including but not limited to, recruitment, hiring, compensation, training, development, promotion, demotion, layoff, recall, furlough, transfer, leave of absence, and dismissal. This is a global policy that applies to all CFA Institute employees, regardless of location. If, due to a disability or current medical condition, you need an accommodation or assistance to complete a job application, you can request one at any stage of the recruitment process. Please send an email to ******************************* noting the accommodations or assistance you are requesting. Please do not include any medical or health information in this email. We will review your request and contact you to discuss the possible options and arrangements. We will try our best to provide you with an accommodation or assistance that meets your needs and respects your preferences. Our application is not compatible with Internet Explorer (IE). We recommend using Chrome.
$50k-55k yearly Auto-Apply 37d ago
Underwriting Support Specialist
Blue Cross Blue Shield of Michigan 4.8
Blue Cross Blue Shield of Michigan job in Columbus, OH
The Underwriting Support Specialist I primarily performs review and entry of new business submissions, as well as provides assistance to the underwriting support services staff to promote timely renewal preparation and policy and endorsement issuance. Reviews, updates and distributes incoming bureau experience modification worksheets. RESPONSIBILITIES/TASKS: Reviews and enters new business submissions: Retrieves incoming submissions from UH Submissions email mailbox. Retrieves incoming Loss Control Analysis requests Checks reservation system for prior receipt of submission. Enters account information, including names, addresses, FEIN, agency and effective date. Enters classifications, payroll and experience mod to rate submission. Consults loss control maps for appropriate system entry of loss control zone. Reviews three-year evaluation of past loss experience noting source and trends, body part, length of service, age of EE, location/department and identifying large losses Completes analysis and files into the Duck system to assign to Loss Control Department Files submission correspondence on OnBase. Communicates completed submission and/or submission issues to underwriters. Handles endorsement transactions for LWMMI accounts per underwriter instructions Handles all new business issues and renewals for LWMMI account per underwriter instructions Reviews, updates and distributes bureau experience modification worksheets: Accesses bureau systems to retrieve worksheets. Compares worksheet experience mod date and factor with experience mod factor and dates in Diamond and updates if appropriate. Distributes mod worksheets to appropriate to support staff. Files experience mod worksheets and corresponding written communication on OnBase. Exports all Account Current Agency Bills and email direct to Agency contacts Assists in new business, renewal, endorsement and cancellation data entry and policy issuance as needed to provide support to the underwriting support services team. Assists in preparing meeting materials for monthly renewal meetings. Assists in other areas of processing as requested. This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required. EMPLOYMENT QUALIFICATIONS: EDUCATION: High school diploma or G.E.D required. Additional college and/or insurance related course study desirable. Combinations of relevant education, certifications, and experience may be considered in lieu of a degree. Continuous learning, as defined by the Company's learning philosophy, is required. Certification or progress toward certification is highly preferred and encouraged. EXPERIENCE: Two years office or clerical support experience in an insurance environment Experience or previous knowledge of worker's Clerical experience in the workers' compensation line of business preferred. Completed relevant educational studies may be considered in lieu of experience. SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED: Ability to learn insurance practices/procedures. Excellent verbal and written communication Ability to organize daily work responsibilities and meet deadlines. Basic knowledge with insurance systems such as policy, billing and/or claims systems. Accurate math and data entry skills. Effective problem solving and attention to detail skills. Ability to work effectively both independently and as a team is essential. Knowledge of computers and standard software programs such as Microsoft Windows including spreadsheet applications and Microsoft Word. Excellent customer service skills WORKING CONDITIONS: Work is performed in an office setting with no unusual hazards. The qualifications listed above are intended to represent the minimum education, experience, skills, knowledge and ability levels associated with performing the duties and responsibilities contained in this job description. PAY RANGE: “Actual compensation decision relies on the consideration of internal equity, candidate's skills and professional experience, geographic location, market and other potential factors. It is not standard practice for an offer to be at or near the top of the range, and therefore a reasonable estimate for this role is between $33,900 and $64,200.” We are an Equal Opportunity Employer. We will not tolerate discrimination or harassment in any form. Candidates for the position stated above are hired on an "at will" basis. Nothing herein is intended to create a contract. #LI-CH1 #CIG
$33.9k-64.2k yearly Auto-Apply 60d+ ago
Field Case Manager Los Angeles, CA Spanish CCM CDMS COHN CRRN
Aetna 4.5
Remote or Los Angeles, CA job
Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come. Excellent benefits package, including 401k, tuition, licensure and certification reimbursement. We promote healthy & wellness lifestyles and offer specialty programs here at Aetna. We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence. Together we will empower people to live healthier lives. Benefit eligibility may vary by position. Click here to review the benefits associated with this position. Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities. We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard. Job Description JOIN OUR GROWING TEAM Are you tired of bedside nursing? Are you looking to get away from 12-hour hospital shifts while continuing to utilize your RN expertise to impact the lives of patients in your local community? We are seeking self-motivated, energetic, detail oriented, highly organized, tech-savvy Registered Nurses to join our Workers' Compensation Field Case Management team. This opportunity offers a competitive salary, full benefits, and a performance-based bonus paid out on a monthly or quarterly basis. POSITION SUMMARY Responsible for assessing and analyzing an injured employee to evaluate the medical and vocational needs required to facilitate the patients appropriate and timely return to work. Acts as a liaison with patient/family, employer, provider(s), insurance companies, and healthcare personnel. Fundamental Components but not limited to the following: Assesses and analyzes an injured employees medical and vocational status; develops a plan of care to facilitate the patients appropriate and timely return to work. Interviews patients in their homes, work-sites, or physicians office to provide ongoing case management services. Monitors patient progress toward desired outcomes through assessment and evaluation. Communicates both in-person and telephonically with patient, medical providers, attorneys, employers and insurance carriers; prepares all required documentation of case work activities. May arrange referrals, consultations and therapeutic services for patients; confers with specialists concerning course of care and treatment. Develops and administers educational and prevention programs. Applies all laws and regulations that apply to the provision of rehabilitation services; applies all special instructions required by individual insurance carriers and referral sources. Testifies as required to substantiate any relevant case work or reports. Daily travel in the field. Qualifications BACKGROUND/EXPERIENCE: Registered Nurse (RN) with active state license in good standing in the state where job duties are performed required Minimum 2 years clinical nursing background required Bilingual Spanish Speaking Fluent preferred Prior case management and workers' compensation experience preferred Ability to multitask in a fast paced work environment Strong computer skills with experience in Microsoft Office Products Excellent communication skills EDUCATION The minimum level of education desired for candidates in this position is a Associate's degree or equivalent experience. LICENSES AND CERTIFICATIONS Nursing/Registered Nurse (RN) is required Nursing/Certified Case Manager (CCM) is desired Telework Specifications: Full time WAH with daily travel in the field. Candidates should reside in the San Fernando Valley/Los Angeles area. Additional Information We offer you: Autonomy Productivity incentive Home every night, weekend and holiday! Schedule Monday-Friday All major holidays are paid time off, vacation and sick time off is accrued. Full benefits offered including 401(k) and many corporate discounts available. Employees are reimbursed for fees to maintain licensure as well as free CEU's to maintain licensure. Continuing Education credits are available/provided for RN and a various industry certifications too. Work from home with in-state travel. In addition to annual salary, position has potential for a monthly monetary bonus. Mileage reimbursement is provided per the IRS rate. Coventry provides laptop, IPhone, fax/scanner/printer, as well as office supplies. Benefit eligibility may vary by position. Click here to review the benefits associated with this position. All employees are expected to embody our values of Excellence, Integrity, Caring and Inspiration in all that they do as an employee. The overall responsibility of the Field Case Manager is to ensure the injured worker receives the best possible care in a timely and efficient manner towards full rehabilitation and return to work. Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come. We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence. Together we will empower people to live healthier lives. Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.
$63k-78k yearly est. 60d+ ago
Risk Adjustment Coding Specialist (Remote)
Carefirst 4.8
Remote or Baltimore, MD job
**Resp & Qualifications** **PURPOSE:** The Risk Adjustment Coding Specialist supports the retrospective risk adjustment supplemental filing, Risk Adjustment Data Validation (RADV) audit and any other chart coding functions, by performing moderately complex medical record review and coding, ensuring compliance with all applicable Federal, State and/or County laws and regulations related to coding and documentation guidelines. The development and ongoing maintenance of the Risk Adjustment Coding guidelines, as well as, guiding junior coding specialists are included in the job responsibilities. **ESSENTIAL FUNCTIONS:** + Verifies accuracy, completeness, and appropriateness of diagnosis codes based on medical documentation provided at all levels of complexity. Utilizes appropriate coding guidelines and recommends any changes to diagnosis codes based on chart review. Achieves and maintains coding accuracy levels greater than 90%. Works with vendors, providers and hospital staff to coordinate record access. + Identifies and documents coding observations or discrepancies and provides information to management team to further enhance quality and/or provider education. Work with leadership and third-party vendors to negotiate agreement on complex medical record diagnoses and determine compliance with coding guidelines which will be accepted by the federal government. Develops and conducts new physician/other healthcare practitioner coding orientation/education, including group or individual sessions. Develop and maintain coding guidelines for Commercial Risk Adjustment, maintaining those guidelines for any changes in industry standards. + Provide guidance and direction to Coding Specialists when reviewing complex medical records to help guide in determining appropriate coding. **SUPERVISORY RESPONSIBILITY:** Position does not have direct reports but is expected to assist in guiding and mentoring less experienced staff. May lead a team of matrixed resources. **QUALIFICATIONS:** **Education Level:** Associate's Degree in Health Information Technology, Business or related field OR in lieu of a Associate degree, an additional 2 years of relevant work experience is required in addition to the required work experience. **Experience:** 3 years risk adjustment/hierarchical condition category (HCC) coding experience. **Knowledge, Skills and Abilities (KSAs)** + Adobe Acrobat Professional. + Microsoft Word, Excel, Outlook, Claims Processing Facets. + Ability to adapt to various coding technology platforms, such as Electronic Medical Record (EMR) or Electronic Health Record (EHR) systems and coding documentation platforms. + Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging. **Licenses/Certifications** : CCS-Certified Coding Specialist or CPS, CCS-P, CRC Upon Hire Required or RHIT - Registered Health Information Technician or RHIA Upon Hire Preferred. Salary Range: $50,976 - $93,456 **Travel Requirements** : 5% medical sites to supervise medical record retrieval, conferences **Salary Range Disclaimer** The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilites of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements). **Department** Risk Adjustment **Equal Employment Opportunity** CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information. **Where To Apply** Please visit our website to apply: ************************* **Federal Disc/Physical Demand** Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs. **PHYSICAL DEMANDS:** The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted. **Sponsorship in US** Must be eligible to work in the U.S. without Sponsorship. \#LI-NH2 REQNUMBER: 21273
$51k-93.5k yearly 60d+ ago
Manager, Account Consultants (Remote)
Carefirst 4.8
Remote or Baltimore, MD job
**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 for Mid-Market (51-99) market segments. Conducts sales and service to assigned accounts. Monitors the development and implementation of strategic long-term customer relationships. Achieves targeted Retention Sales goals for the unit. **ESSENTIAL FUNCTIONS** + Develops account strategies in accordance with overall strategy. Works with the team and Brokers to maximize retention and growth. Manages the Renewal support/service functions essential to day-to-day account, service, productivity, implementation and retention. + Develops account goals and business plan with customer. + Conducts regular reviews of business performance, promotion strategies, and planograms. + Forecasts, budgets, and tracks account revenues and cost for a single account. + Responsible for staff development and ongoing monitoring of metrics to measure performance. + Reporting responsibilities for team Retention, Incentive and Books of Business for Consultants. **QUALIFICATIONS** **Education Level:** Bachelor's Degree in Business, Finance or related field. In lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience. **Experience:** + 5 years sales experience. + 1 year supervisory experience or demonstrated progressive leadership experience. **Licenses/Certifications:** + Current health and life license for the jurisdictions of Maryland, DC, and Virginia is required. **Preferred Qualifications** + Experience in a health care setting in sales. **Knowledge, Skills and Abilities (KSAs)** + Strong presentation skills. + Strong negotiation and relationship building skills. + Excellent communication skills both written and verbal. + Microsoft Applications. + Knowledge and understanding of CRM,Excel and Salesforce, and other client management tools. **Salary Range:** $112,000 - $189,000 (Base Salary Range is based on education, experience & internal equity plus this role offers a Sales Incentive). **Salary Range Disclaimer** The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements). **Department** Renewal 51-99 **Equal Employment Opportunity** CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information. **Where To Apply** Please visit our website to apply: ************************* **Federal Disc/Physical Demand** Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs. **PHYSICAL DEMANDS:** The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted. **Sponsorship in US** Must be eligible to work in the U.S. without Sponsorship \#LI-KL1 REQNUMBER: 21536
$112k-189k yearly 19d ago
Office Manager
FTE 4.1
Lima, OH job
Managers plan, direct, and coordinate supportive services of an organization, such as recordkeeping, mail distribution, telephone operator/receptionist, and other office support services.
$46k-62k yearly est. 60d+ ago
Manager, Broker Relations (Remote)
Carefirst 4.8
Remote or Baltimore, MD job
**Resp & Qualifications** **PURPOSE:** The Broker Relations Manager's primary responsibility is to bring the value of CareFirst to the marketplace by engaging and working with CareFirst's distribution channel (brokers). This role combines strategic leadership with hands-on management to ensure brokers receive timely, accurate, and comprehensive assistance. The ideal candidate will foster a customer-centric culture while driving operational excellence and team development. **ESSENTIAL FUNCTIONS:** **Broker Relationship Management** + Serve as the primary escalation point for complex broker inquiries and issues, ensuring timely and satisfactory resolution. + Build and maintain strong relationships with key broker partners, full service producers and consultants, understanding their needs and business objectives. + Monitor broker satisfaction metrics and implement strategies to improve service delivery and partner experience. + Collaborate with sales and account management teams to support broker growth and retention initiatives. **Team Leadership & Development** + Lead, mentor, and develop a team of broker support representatives, fostering a collaborative and high-performance culture. + Conduct regular performance reviews, provide coaching, and identify training opportunities to enhance team capabilities. + Manage team scheduling, workload distribution, and resource allocation to ensure optimal coverage and efficiency. + Recruit, onboard, and train new team members in company policies, systems, and broker service best practices. Operational Excellence + Develop and implement broker service standards, workflows, and standard operating procedures to ensure consistent, high-quality support. + Monitor key performance indicators including response time, resolution time, ticket volume, quality and customer satisfaction scores. + Identify process improvement opportunities and implement solutions to enhance efficiency and service quality. + Manage and optimize the use of Broker360 and ticketing systems to track interactions, issues, and resolutions. + Ensure compliance with regulatory requirements, company policies, and industry standards. + Drive development and adoption of service dashboard(s) to track performance and progress, including broker-level dashboards. + Drive development and ongoing enhancement of broker portals to drive continued automation of broker work with CareFirst. + Support enhancements to Salesforce CRM to drive better data collection and reporting opportunities. **Communication & Collaboration** + Partner with Product, Underwriting, Operations, and IT departments to resolve systemic issues and improve broker experience. + Prepare and present regular reports on team performance, broker feedback, and service trends to senior leadership. + Communicate policy updates, system changes, and important information to the team and broker community. + Facilitate regular staff meetings to share updates, celebrate successes, and address challenges. + Attend and participate in business and community activities to promote CareFirst and identify new opportunities as needed. **SUPERVISORY RESPONSIBILITY:** This position manages people. **QUALIFICATIONS:** **Education Level** : Bachelor's Degree in marketing, business or related field OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience. **Experience:** + 5 years in sales, relationship management and/or marketing. + 1 year supervisory experience or demonstrated progressive leadership experience. **Licenses/Certifications:** + A current Health/Life License in Maryland, Virginia, and District of Columbia is required **Preferred Qualifications:** + Previous experience working directly with insurance brokers or agencies. + Lean Six Sigma or process improvement certification. + Experience implementing or managing CRM or customer service technology platforms. **Knowledge, Skills and Abilities (KSAs)** + Leadership & Team Development: Ability to inspire, motivate, and develop team members while maintaining accountability. + Problem-Solving: Strong analytical skills with ability to identify root causes and implement effective solutions. + Communication: Excellent written and verbal communication skills with ability to explain complex concepts clearly. + Relationship Building: Skilled at building trust and rapport with internal stakeholders and external partners. + Organization & Time Management: Ability to prioritize competing demands and manage multiple projects simultaneously. + Adaptability: Comfortable with ambiguity and able to adjust strategies in response to changing business needs. + Customer Focus: Unwavering commitment to understanding and exceeding broker and customer expectations. + Data-Driven Decision Making: Ability to interpret metrics and analytics to drive continuous improvement. Salary Range: $108,400 - $201,218 **Salary Range Disclaimer** The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements). **Department** Client Relationship Managers **Equal Employment Opportunity** CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information. **Where To Apply** Please visit our website to apply: ************************* **Federal Disc/Physical Demand** Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs. **PHYSICAL DEMANDS:** The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted. **Sponsorship in US** Must be eligible to work in the U.S. without Sponsorship. \#LI-KL1 REQNUMBER: 21520
$108.4k-201.2k yearly 15d ago
Senior Advisor
The FTE Global Advisory Network 4.1
Remote or Detroit, MI job
- up to 90% travel US-based At FTE Factory Advisors, we partner with manufacturing and industrial leaders to solve complex operational challenges, delivering measurable results and lasting impact. As a Senior Advisor within our Global Advisory Network, you'll work directly with clients to streamline processes, improve performance, and create sustainable change-often on-site where the action happens. About Us FTE Factory Advisors is an operational consulting firm that delivers integrated business solutions to help clients achieve stronger results, faster. We work side-by-side with client teams, combining deep industry knowledge with hands-on execution. Our Global Advisory Network brings together independent experts across multiple disciplines, creating a collaborative powerhouse of knowledge, experience, and capability. The Opportunity As a Sr. Advisor, you will serve as both a strategic partner and a tactical problem-solver for our clients. You'll operate as an independent contractor (LLC or S-Corp) within our network, enjoying the flexibility of consulting while benefiting from the credibility and reach of the FTE brand. Disciplines We Seek We are actively building our network of Senior Advisors across a broad range of expertise, including: Operations Management Purchasing & Sourcing Supply Chain Management Quality Management Lean Manufacturing / Continuous Improvement Technical Engineering Maintenance & Reliability Leadership Development & Organizational Change Process Improvement Production Planning & Scheduling Industrial Engineering Project Management Environmental, Health & Safety (EHS) Artificial Intelligence in Manufacturing - including AI-driven process optimization, predictive maintenance, machine vision, and data analytics for improved decision-making. If your discipline is not listed here but aligns with operational, technological, and manufacturing excellence, we still want to hear from you. What You'll Do Develop Specialized Knowledge - Build deep expertise in your discipline and apply it to manage complex components of FTE client projects. Collaborate in Small Teams - Work closely with other FTE Sr. Advisors and client leaders to design strategies, capabilities, systems, and processes that deliver measurable, bottom-line results-and ensure those results are sustainable. Serve as a Trusted Advisor - Partner with client department managers to implement improved processes and operations, guiding them through organizational change. Lead and Support Client Engagements - Contribute to project planning, organization, and execution while maintaining a focus on client outcomes. Analyze and Improve Operations - Gather, organize, and evaluate case, client, financial, and operational data; observe on-site operations to identify areas for improvement. Develop Solutions and Best Practices - Recommend alternative methods, process optimizations, and operational enhancements to improve performance. Create High-Impact Deliverables - Produce project plans, cost-benefit analyses, written reports, and presentations that clearly communicate recommendations and progress. Support Business Development - Contribute to new proposals, pricing models, and client research to expand engagement opportunities. Coach and Mentor - Guide client teams in implementing new industry approaches, empowering them to achieve sustainable, lasting results. Anticipate and Manage Risks - Identify potential project risks early, communicate them effectively, and develop proactive solutions to keep initiatives on track. Requirements What We're Looking For Minimum Experience Required: Experience: 15+ years in relevant operational, manufacturing, or industrial leadership roles. Expertise: Proven track record in driving operational excellence, cost efficiency, and team performance. Soft Skills: Strong communicator, adaptable problem-solver, and active listener who thrives in challenging environments. Mindset: Self-starter who works independently while building collaborative relationships with clients and peers. Structure: Ability to operate as an independent consultant via LLC or S-Corp. Desired Experience but not required: Experience Leading and Implementing Lean and/or Six Sigma methodologies Experience leading cross-functional teams Direct experience as an internal or external consultant Key Attributes: Ability to work independently and adapt quickly to project needs Thrives in challenging manufacturing environments Enjoys travel and is most at home working in challenging industrial environments Demonstrates Active listening skills: seeking first to understand and then to be understood Is capable of coaching others to use their knowledge and skills to overcome challenges Benefits Why Join the FTE Global Advisory Network? Impact: See your work translate into real results-fast. Flexibility: Choose the projects and timelines that fit your business and lifestyle. Collaboration: Work alongside a diverse, high-caliber group of professionals who share your passion for excellence. Credibility: Leverage the strength and reach of the FTE Factory Advisors brand while maintaining your independence.
$97k-134k yearly est. Auto-Apply 22d ago
Actuary - Pharmacy (Remote)
Carefirst 4.8
Remote or Baltimore, MD job
**Resp & Qualifications** **PURPOSE:** Performs advanced actuarial and oversight skills in the performance of actuarial analytics to develop actionable items in support of departmental goals Provides actuarial leadership support to Medical, Pricing, Underwriting, Sales, Finance and other applicable Business Units. Responsible for actuarial modeling to support financial objectives. and making recommendations to executives and senior management. **ESSENTIAL FUNCTIONS:** + Responsible for directing the efforts of Actuarial staff (Pricing, Actuarial Finance, Actuarial Medicare Advantage, Actuarial Innovation and Research) to accomplish near and long-term goals set by senior management. + In collaboration with senior management, responsible for setting long term strategy within the Actuarial department. + Responsible for representing the Actuarial department to internal and external customers including state and federal regulators. + Hiring, recruiting and developing a purpose-driven, growing team with balanced, optimal work distribution, visibility and SOA exam success. **SUPERVISORY RESPONSIBILITY:** This position manages people. **QUALIFICATIONS:** **Education Level:** Bachelor's Degree in Actuarial Science, Finance, Mathematics or related field OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience. **Licenses/Certifications Upon Hire Required:** Fellow of the Society of Actuaries (FSA) **Experience:** 8 years progressively responsible pricing and actuarial experience in health care. 3 years management experience. **Knowledge, Skills and Abilities (KSAs)** + Extremely knowledgeable of risk evaluation and rating techniques and thoroughly familiar with a variety of health insurance products including HMO?s, Indemnity, POS/Opt-Out, Consumer-Driven and other products. + Possesses highly developed analytical skills and excellent interpersonal and communication skills, both written and oral, to the point where complex actuarial and underwriting issues are effectively conveyed to a diverse audience. + Must have computing skills with both PC-based and mainframe applications. + Strong leadership skills, as well as the ability to effectively negotiate and sell company rating policy. + Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging. **Salary Range:** $168,960 - $313,632 **Salary Range Disclaimer** The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements). **Department** PBM **Equal Employment Opportunity** CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information. **Where To Apply** Please visit our website to apply: ************************* **Federal Disc/Physical Demand** Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs. **PHYSICAL DEMANDS:** The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted. **Sponsorship in US** Must be eligible to work in the U.S. without Sponsorship \#LI-CB1 REQNUMBER: 21588
$91k-124k yearly est. 26d ago
Small Group Sales Consultant I (Remote)
Carefirst 4.8
Remote or Baltimore, MD job
**Resp & Qualifications** **PURPOSE:** The Small Group Existing Business Sales Consultant serves as the primary strategist and revenue leader for a defined territory of small group brokers, and their associated employers. Unlike traditional account service roles, this position will not manage day-to-day broker service issues those are handled by the Broker Service Team. Instead, the consultant is responsible for retention strategy, renewal positioning, revenue optimization, and broker ecosystem engagement. This role mirrors the strategic expectations of our manager-level sales leadership: driving clarity, elevating performance, and ensuring our market voice is consistent, compelling, and effective. The consultant functions as the internal authority on the assigned relationships the person the broader organization turns to for insights on portfolio health, competitive threats, renewal decisions, and growth strategy. **ESSENTIAL FUNCTIONS:** **Relationship Ecosystem Management** + Organize brokers and employer groups into relationship ecosystems, identifying influence networks, key producing clusters, and regional patterns. + Lead relationship engagement across these ecosystems, ensuring brokers receive consistent, strategic messaging and renewal support, not just performing service work. + Act as the strategic face of CareFirst to broker partners, elevating our value proposition and shaping how we show up in the market. + Partner closely with the Broker Service Team, who owns service delivery and issue resolution, ensuring a seamless and coordinated experience. + Facilitate escalations appropriately through service teams while maintaining focus on higher-order strategy, messaging, and relationship management. **Renewal Excellence & Competitive Positioning** + Lead renewal strategy conversations with brokers and internal teams; articulate competitive positioning, product differences, and value drivers. + Prepare and deliver compelling renewal presentations, tailored narratives, and portfolio-level insights for brokers and employer decision-makers. + Partner with underwriting, product, operations, sales leadership, and market strategy to ensure renewals are timely, accurate, and aligned with enterprise goals. + Strengthen consistency and quality of renewal execution by identifying process gaps, improving handoffs, and proposing enhancements to cross-functional workflows. **Internal Influence, Communication & Thought Leadership** + Serve as the internal subject matter expert on the assigned relationships, serving as trusted partner to brokers for insights, risks, or needed actions. + Communicate market feedback, broker sentiment, competitor behavior, and emerging threats to sales leadership and cross-functional partners. + Support the creation of strategic sales messaging, broker communications, market-level talking points, and competitive counter-strategies. + Participate in staff meetings, pipeline reviews, strategic planning sessions, and quarterly business reviews to represent the voice of the existing book. + Contribute to a high-performance, accountable culture by modeling preparation, clarity, rigor, and professional presence. **QUALIFICATIONS:** **Education Level:** Bachelor's Degree in Business, Finance or related field OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience. **Licenses/Certifications Upon Hire Required:** + Current health and life license for the jurisdictions of Maryland, DC, and Virginia. **Experience:** 3 years sales/healthcare experience in a similar sales position. **Preferred Qualifications:** + Experience in a similar sales position with a competitor or another Blue Cross Blue Shield plan is preferred. **Knowledge, Skills and Abilities (KSAs)** + Knowledge and understanding of CRM, Salesforce, and other client management tools. + Strong customer service orientation. + Ability to recognize, analyze, and solve a variety of problems. + Excellent communication skills both written and verbal. + Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging. **Salary Range:** $60,800 - $98,800 **Salary Range Disclaimer** The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements). **Department** SM SBU New Business **Equal Employment Opportunity** CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information. **Where To Apply** Please visit our website to apply: ************************* **Federal Disc/Physical Demand** Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs. **PHYSICAL DEMANDS:** The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted. **Sponsorship in US** Must be eligible to work in the U.S. without Sponsorship \#LI-KL1 REQNUMBER: 21583
$60.8k-98.8k yearly 38d ago
Organizational Quality Lead (Remote)
Carefirst 4.8
Remote or Baltimore, MD job
**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 CMMI). Serve as the technical and strategic resource for quality management, driving process optimization, stakeholder engagement, and organizational change to achieve high standards of performance and compliance. **ESSENTIAL FUNCTIONS:** + Champion the implementation and ongoing maturity of a quality framework (ISO, CMMI, or similar), including assessment, training, and certification activities. + Lead cross-functional teams to identify gaps, redesign processes, and deliver measurable improvements in quality, efficiency, and customer satisfaction. + Develop and execute project plans for framework rollout, including stakeholder buy-in, change management, and communication strategies. + Facilitate formal assessments, corrective actions, and continuous improvement cycles, ensuring alignment with industry standards and organizational goals. + Build and maintain relationships with executive leadership, translating technical and process information into actionable insights for decision-making. + Guide teams through organizational change, fostering a culture of transparency, accountability, and continual improvement. + Partner with IT and business stakeholders to ensure quality processes support strategic objectives and regulatory requirements. **SUPERVISORY RESPONSIBILITY:** Position does not have direct reports but is expected to assist in guiding and mentoring less experienced staff. May lead a team of matrixed resources. **QUALIFICATIONS:** **Education Level:** Bachelor's Degree in Computer Science, Information Technology, or related fields OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience. **Licenses/Certifications:** + CMMI Associate (preferred) + PMP (preferred) + Relevant Professional certifications from recognized business associates (Lean Six Sigma, CSM, CSPO, etc.) strongly preferred **Experience:** 8 years of relevant process engineering experience or demonstrated ability to perform the functions at the level required. **Preferred Qualifications:** + Advanced degree **Knowledge, Skills and Abilities (KSAs)** + **Project Management:** Proven ability to lead complex, multi-phase projects, manage competing priorities, and deliver results on time and within scope. + **Adaptability:** Comfortable navigating organizational change, ambiguity, and evolving requirements; able to pivot strategies and approaches as needed. + **Executive Communication:** Skilled at synthesizing complex topics into clear, concise presentations and reports for senior leadership; able to influence and drive alignment across all levels of the organization. + **Quality Framework Expertise:** Deep understanding of ISO 9001, CMMI, or similar frameworks, including practical experience with implementation, assessment, and certification. + **Stakeholder Engagement:** Strong relationship-building skills, with a track record of collaborating across IT, business, and external partners to achieve shared goals. + **Continuous Improvement:** Demonstrated ability to identify process inefficiencies, lead root cause analysis, and implement sustainable improvements. + **Change Management:** Experience guiding teams through change initiatives, including training, communication, and resistance management. + Ability to motivate others and foster a culture of continuous improvement and agile execution. + Ability to exercise independent judgment in methods, techniques, and evaluation criteria. + Knowledge of process improvement techniques. + Knowledge of process mapping and documentation techniques. + Ability to work with data and analytics. + Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging. **Salary Range:** $103,536 - $205,634 **Salary Range Disclaimer** The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements). **Department** Quality Services **Equal Employment Opportunity** CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information. **Where To Apply** Please visit our website to apply: ************************* **Federal Disc/Physical Demand** Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs. **PHYSICAL DEMANDS:** The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted. **Sponsorship in US** Must be eligible to work in the U.S. without Sponsorship \#LI-MK1 REQNUMBER: 21636
$103.5k-205.6k yearly 3d ago
Lead Business Analyst (Remote)
Carefirst 4.8
Remote or Reston, VA job
**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 and verifying the needs of business or user. The incumbent is accountable for leading the gathering and synthesizing of business requirements for high complexity software, systems, processes and/or services and translating them into specifications ensuring the business objectives are met. As the functional expert, the incumbent serves as a strategic conduit between the business area and the technical or software development team through which requirements flow. **ESSENTIAL FUNCTIONS:** + Interprets business needs and issues by gathering, eliciting, creating, analyzing, documenting and validating the Business area?s user and/or technical (functional/non-functional) requirements. Key contributor in the creation of project plans to define, organize and schedule requirements management and development activities. Provides oversight and strategic direction to lower-level analysts which includes coaching, mentoring, and delegating of tasks and deliverables. Facilitates requirements analysis and verification sessions. Accountable in the tracking and management of open issues and assists in planning for resolution. Responsible for successful development sessions and design reviews in order to ensure design meets user requirements. + Responsible for overall success of user acceptance testing, including documentation, verification and release. Implements practices and procedures for end user test plans. Identifies and documents gaps in requirement adherence or system deficiencies/defects and coordinates appropriate action through issue resolution. Leads in creating formal communication to be delivered to relevant stakeholders. Providing guidance and training to application end users. + Identifies, documents and troubleshoots problems with their in-depth knowledge of the relationships in systems, software and processes. Collaborate with appropriate stakeholders to monitor, report and resolve issues. Participates in the development of solutions and workarounds that solve high complexity technical, system and/or business issues. + Reviews, analyzes and creates detailed documentation of business systems, processes, software and user needs. Responsible for writing all documentation to established standards, in a clear and well-organized manner. Develops and/or collaborates in key project and requirement deliverables for projects of high complexity. + Monitors and reports project status to identify and mitigate risks and to ensure quality and timely deliverables. Coordinates assigned projects from concept through implementation. Prioritize and manage new work requests. + Answers policy-related questions for business process, systems and software which require research and consultation with others internally and externally. **SUPERVISORY RESPONSIBILITY:** Position does not have direct reports but is expected to assist in guiding and mentoring less experienced staff. May lead a team of matrixed resources. **QUALIFICATIONS:** **Education Level:** Bachelor's Degree in Business Administration, Business Management, Finance or related field OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience. **Experience:** 8 years progressive experience in business analysis, systems analysis, testing or other analytical experience. **Preferred Qualifications:** + Master's Degree MBA + Demonstrated ability to have led the delivery of high quality, effective deliverables on-time and be a significant contributor to the development of cost-effective solutions. + Expert understanding of business analysis core competencies. + Prior business analysis coaching and mentoring experience. **Knowledge, Skills and Abilities (KSAs)** + Strong time-management and organizational skills. + Excellent communication skills both written and verbal. + Ability to organize stakeholder meetings. + Use of Microsoft Office applications. + Ability to train and mentor others. + Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging. **Salary Range:** $85,320 - $169,455 **Salary Range Disclaimer** The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements). **Department** Enrollment Product Management **Equal Employment Opportunity** CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information. **Where To Apply** Please visit our website to apply: ************************* **Federal Disc/Physical Demand** Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs. **PHYSICAL DEMANDS:** The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted. **Sponsorship in US** Must be eligible to work in the U.S. without Sponsorship REQNUMBER: 21651
$85.3k-169.5k yearly 3d ago
Senior Systems Administrator - Ariba (Remote)
Carefirst 4.8
Remote or Baltimore, MD job
**Resp & Qualifications** **PURPOSE:** The Senior Systems Administrator is responsible for assisting with the development and maintenance of unique software platforms. Assists the Manager with the administration, integration and maintenance of system platform. This position assesses internal business process for efficiency in leveraging the system's platform. Additionally, the Sr. Systems Administrator is responsible for data reporting, configuration, analytics, and dashboarding, resulting from the application. Coordinates and/or facilitates meetings that support projects related to the system (i.e. Kickoff, Business Requirements, Proof of Concept, Trainings, etc.) as well as the provision of specific guidance and direction to various internal business stakeholders. On an ongoing basis, the Sr. Systems Administrator will maintain content integrity of the system's software. **ESSENTIAL FUNCTIONS:** + Responsible for operational governance oversight. Provide advisory support in the identification of control improvement and governance opportunities. Maintain documentation for governance and re-performance ability by leveraging the system software solution. Coordinate and conduct internal operational/process level audits. Continuously analyze and align all functional area policies, procedures, SOPs, workflows and systems to ensure compliance and alignment with regulations, contractual commitments and mandates. Review complex business processes, identify, document, and elevate the presence of risks and controls, and/or management controls in each functional area to mitigate any risk or exposure. Assists in the diagnosis and resolution of problems and works with the system software vendor to implement solutions. Test/validate changes to correct or enhance systems. Work with Subject Matter Resources in interacting with customers, (internal & external). Elicit, review, analyze, interpret, and document requirements for business/system needs. Perform business and technical designer functions, including contributing to both the business and technical architecture components, supporting functional area business process specialists, architects, product and technology specialists. Extract data from the system software solution and develop front end presentation and dashboarding. Work with system vendor and internal stakeholders to isolate and solve design problems or data anomalies encountered during testing and implementation stages. Assist in the creation of test cases to validate changes made to correct or enhance the system software solution. Serve as Subject Matter Resources in customer interaction (internal & external). + Responsible for gaining the ability to navigate the system software application along with a full understanding of the objectives system software application and communicating those objectives and requirements. Assists in the analysis of existing workflows as well as the implementation of new workflows. Ensures the application?s solutions for compliance management are identified and understood, communicated and adopted corporate-wide. Responsible for developing and delivering ad-hoc reports with analysis on a regular basis, or as requested. Day to day maintenance of application content along with associated documentation. Develop training materials and provide guidance and direction to all associate users for general use of the application. + Performs as the day-to-day maintenance of the system software platform. Responsible for ongoing day to day routine maintenance of the system software application including but not limited to user assistance, training, assisting with testing, workflows, monitors user feedback and addresses user questions; navigating all aspects of the application; and proactively identifies future opportunities and enhancements to the application + Collaborates with the system vendor for initializing any subsequent software system upgrades or new application modules. Ensures appropriate product-related training and documentation are made available to end users. Communicates technical and business problems clearly and in a concise manner to achieve resolution. **SUPERVISORY RESPONSIBILITY:** Position does not have direct reports but is expected to assist in guiding and mentoring less experienced staff. May lead a team of matrixed resources. **QUALIFICATIONS:** **Education Level:** Bachelor's Degree in Computer Science, Business or related field OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience. **Experience:** 5 years' experience in a systems administration or closely related role. **Knowledge, Skills and Abilities (KSAs)** + Knowledge of system security and data backup/recovery. + Excellent communication skills both written and verbal. + Knowledge of various operating systems and platforms. + Ability to recognize, analyze, and solve a variety of problems. + Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging. **Salary Range:** $81,216 - $161,304 **Salary Range Disclaimer** The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements). **Department** Procurement & Vendor Management **Equal Employment Opportunity** CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information. **Where To Apply** Please visit our website to apply: ************************* **Federal Disc/Physical Demand** Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs. **PHYSICAL DEMANDS:** The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted. **Sponsorship in US** Must be eligible to work in the U.S. without Sponsorship \#LI-CB1 REQNUMBER: 21515
$81.2k-161.3k yearly 44d ago
Claims Adjuster I (Remote)
Carefirst 4.8
Remote or Baltimore, MD job
**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 and summarizing out-of-line situations; recommending changes in operating processes; completing reports, logs, and audit records. **ESSENTIAL FUNCTIONS:** + Proactively investigate and perform adjustments of claims. Ensure claims are handled within authority limits, and in line with standard procedures and guidelines. + Updates claims audit records by entering, verifying, and securing data. + Settle standard/complex claims through payment or denial. + Provides claims audit information and reports by collecting, analyzing, and summarizing data and trends. + Improves claims adjustment job knowledge by attending training sessions. **QUALIFICATIONS:** **Education Level:** High School Diploma or GED. **Experience:** 3 years' claims experience and complete understanding of all systems, policies and procedures. **Knowledge, Skills and Abilities (KSAs)** + Ability to analyze information gathered from investigation. + Excellent communication skills both written and verbal. + Ability to recognize, analyze, and solve a variety of problems. + Skill in completing assignments accurately with attention to detail. + Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging. **Salary Range:** $36,144 - $66,264 **Salary Range Disclaimer** The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements). **Department** Medicare/Medicaid Claims **Equal Employment Opportunity** CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information. **Where To Apply** Please visit our website to apply: ************************* **Federal Disc/Physical Demand** Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs. **PHYSICAL DEMANDS:** The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted. **Sponsorship in US** Must be eligible to work in the U.S. without Sponsorship REQNUMBER: 21662
$36.1k-66.3k yearly 2d ago
Principal Data Product Manager (Remote)
Carefirst 4.8
Remote or Baltimore, MD job
**Resp & Qualifications** **PURPOSE:** Your role involves managing the entire lifecycle of enterprise data products and services to align with company goals. You will lead the strategic direction of data products and coordinate teams of business leaders, data engineers, data architects, data analysts, and data scientists. As a Data Product Manager, you will establish and execute the data product operating model, define the vision and strategy for data products, implement product management processes, and produce roadmaps for high-quality, high-performing data products. You will also deliver data solutions that enhance the analytical experiences of CareFirsts customers and internal teams. You create value from the organization's data assets and enable internal/external analytics and insights. This includes developing strategies to achieve business outcomes, drive innovation, and ensure compliance with regulatory, legal, and ethical requirements. You will collaborate with customers, business stakeholders, data architects, data scientists, data engineers, and product owners to build the data foundation for the data product catalog. Your team will gather requirements, write use cases, organize features, implement tools, and establish metrics for managing the data product lifecycle and maintaining a data product catalog or subscription. **ESSENTIAL FUNCTIONS:** + Product Strategy: Develop and maintain the Data Product Vision, Strategy, and Roadmap with input from various stakeholders. Define success metrics and strategic priorities, partner on enhancement requests, and prioritize them. Work with customers and internal stakeholders to understand and translate their needs into data platform requirements. + Product Discovery: Utilize enterprise information assets and analytics for decision-making and regulatory reporting. Lead the development of data and analytics products with Data Directors and Data Product Managers. Oversee deploying the enterprise's data and analytics platform, ensuring quality, traceability, timeliness, usability, and cost-effectiveness. + Product Lifecycle Management: Collaborate with Data Directors, Data Product Managers, and SMEs to finalize data requirements. Work with the engineering team through planning, iteration. + Team Leadership: Lead a cross-functional teams to achieve departmental, divisional, and enterprise goals. + Market Research & Competitive Intelligence: Promote data capabilities internally and externally. Assess competitors' data offerings and identify market opportunities. Assist with customer communications and scan for emerging data management strategies, tools, and technologies. **QUALIFICATIONS:** **Education Level:** Bachelor's Degree in Computer Science, Information Technology, or related field OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience. **Experience:** 10 years Experience in Architecture Domain. **Preferred Qualifications** : Advanced degree. **Knowledge, Skills and Abilities (KSAs)** + Ability to motivate and influence others so that project objectives are met in a timely manner. + Ability to collaborate with stakeholders to develop high quality solutions. + Ability to coach, delegate, and develop architects and engineers. + Ability to manage cross-domain architecture solutions and issues. + Expertise with domain related architecture frameworks, methods and tools. + Effective organizational, interpersonal/relationship management, analytical, communications (written and verbal) and collaboration. Salary Range: $152,080 - $271,843 **Salary Range Disclaimer** The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilites of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements). **Department** 2024-2026 PBM/Pharmacy RFP Pro **Equal Employment Opportunity** CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information. **Where To Apply** Please visit our website to apply: ************************* **Federal Disc/Physical Demand** Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs. **PHYSICAL DEMANDS:** The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted. **Sponsorship in US** Must be eligible to work in the U.S. without Sponsorship. \#LI-HS1 REQNUMBER: 21265
$92k-121k yearly est. 60d+ ago
Web Developer
FTE 4.1
Lima, OH job
requires filing skills. We require a BA in Office Management Skills. Please apply!
$60k-80k yearly est. 60d+ ago
Senior Sourcing Associate (Remote)
Carefirst 4.8
Remote or Baltimore, MD job
**Resp & Qualifications** **PURPOSE:** Executes medium to complex sourcing projects, from start to finish. This role will rationalize the supply base through strategic sourcing, lead cross-functional team to achieve optimal total cost of ownership, identify cost savings opportunities across the company, support overall supply requirements and ensure an effective spend analysis for assigned category. **ESSENTIAL FUNCTIONS:** + Provides sourcing services (RFx, reverse auctions, negotiations) to clients based on predefined service levels, managing 5-12 simple to complex projects simultaneously with limited supervision/guidance or independently. Executes sourcing strategy by leading formal sourcing processes including stakeholder engagement, RFP processes and contract negotiations. Assists in the development of category sourcing strategy leading cross-functional teams to execute the sourcing strategy. Partners with customer groups to establish specifications for assigned commodity categories. Perform market analysis, benchmark analysis and spend analysis for assigned commodity categories. + Assists in ensuring realized savings ties back to departmental and/or customer budgets. Maintains and supports expenditure controls and alignment with the company's and departments budget and fiduciary requirements. Supports and improves supply base development programs (e.g., supplier diversity, local economic development, green sustainability programs). Ensures compliance with operational requirements, internal controls and regulations. Establishes optimal buying channel/ordering process aligned to category strategy utilizing technology aligned with overall procurement strategy. + Partners with business units and legal team in the negotiation of contracts and agreements, including Master Services Agreements (MSAs), Statements of Work (SOWs) and Service Level Agreements (SLAs). Assists and consults with the business partners to create Service Level Agreements to effectively measure and manage supplier performance. + Assists in the development of commercial strategies for sourcing to meet present and future supply requirements by applying advanced knowledge of purchasing principles, contract law, and commodities. Continually searches out new sourcing opportunities to implement as needed to maintain competitive advantage. Assists in the development and management of the corporate wide, programs, policies, and procedures that support the Company Supplier Diversity strategy. **SUPERVISORY RESPONSIBILITY:** Position does not have direct reports but is expected to assist in guiding and mentoring less experienced staff. May lead a team of matrixed resources. **QUALIFICATIONS:** **Education Level:** Bachelor's Degree in Business Administration or related field OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience. **Licenses/Certifications Preferred:** + Certified Purchasing Manager (C.P.M). **Experience:** 5 years strategic sourcing experience. **Preferred Qualifications:** + Ability to track technology trends. + Knowledge of the FAR. + Knowledge of Ariba or similar procurement automation tools. + Demonstrated Success in leading project teams to achieving quantifiable savings by applying sourcing methods **Knowledge, Skills and Abilities (KSAs)** + Ability to work with cross-functional teams. + Ability to negotiate internally and externally to achieve required objectives and executes and implement contracts. + Strong customer focus and ability to drive change. + Knowledge of sourcing systems and preferable e-sourcing technology. + Ability to extract data and summarize key elements to focus on. + Knowledge of contract law, government policies and regulations for the food and drug industry. + Strong meeting management and facilitation skills, while being self-motivated. + Effective presentation and analytical skills to interface with multiple levels of management. + Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging. **Salary Range:** $76,536 - $152,009 **Salary Range Disclaimer** The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilites of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements). **Department** Sourcing and Procurement **Equal Employment Opportunity** CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information. **Where To Apply** Please visit our website to apply: ************************* **Federal Disc/Physical Demand** Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs. **PHYSICAL DEMANDS:** The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted. **Sponsorship in US** Must be eligible to work in the U.S. without Sponsorship \#LI-CB1 REQNUMBER: 21116
$76.5k-152k yearly 60d+ ago
Sales Consultant II - New Business Development (Remote)
Carefirst 4.8
Remote or Baltimore, MD job
**Resp & Qualifications** _CANDIDATES MUST LIVE IN THE MD, DC, NORTHERN VIRGINIA AREA IN ORDER TO TRAVEL INTO THE OFFICES AND FOR CLIENT MEETINGS AND STAFF MEETINGS_ **PURPOSE:** This position is responsible for **new business development** within the **middle market customer** space. This role leads sales initiatives and strategies as well as relationship building with both our external partners and prospects as well internal constituents. The sales consultant position requires a level of knowledge and understanding for selling to fully and self-insured customers with complex benefit arrangements. **ESSENTIAL FUNCTIONS:** + Achieve sales goals and profitable growth for the organization. + Position and sell multiple lines of coverage, medical, stop loss, dental and vision. + Excellent written and presentation skills. + Strategize on proposals to ensure we are meeting the clients objectives and delivering our value proposition. + Be proactive, organized, responsive, detail oriented and track all sales data within the required platforms. + Develop long term relationships with both internal and external constituents. + Ability to strategize and organize a team of subject matter experts for finalist meetings. + Continuously meet with our consultant partners and keep them informed on new products, updates, and relevant information to their business. **SUPERVISORY RESPONSIBILITY:** Position does not have direct reports but does require working closely with internal constituents to develop strategies for selling and presenting to consultants and prospects. **QUALIFICATIONS:** **Education Level:** Bachelors degree in business, Insurance Industry, or related field OR in lieu of a bachelors degree, an additional 4 years of relevant work experience is required in addition to the required work experience. **Licenses/Certifications:** + Current health and life license for the jurisdictions of Maryland, DC, and Virginia Required. **Experience:** 5 years sales/healthcare in a similar sales position. **Preferred Qualifications:** + 5+ years experience in a similar sales position with a competitor or similar industry. **Knowledge, Skills, and Abilities (KSAs)** + Ability to recognize, analyze, and solve for prospects challenges. + Excellent communication skills both written and verbal. + Must be able to meet established deadlines for proposals and work closely with internal constituents. **Travel Requirements** **Estimate Amount:** 80% This position is expected to travel to see consultants and prospective clients within the DC metro area. **Salary Range:** $72,000 - $117,000 **Salary Range Disclaimer** The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilites of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements). **Department** CMLG New Business MD **Equal Employment Opportunity** CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information. **Where To Apply** Please visit our website to apply: ************************* **Federal Disc/Physical Demand** Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs. **PHYSICAL DEMANDS:** The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted. **Sponsorship in US** Must be eligible to work in the U.S. without Sponsorship \#LI-KL1 REQNUMBER: 21368
$35k-60k yearly est. 60d+ ago

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Updated December 31, 2025

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Blue Cross Blue Shield of Michigan may also be known as or be related to BLUE CARE NETWORK OF MICHIGAN, Blue Cross Blue Shield Of Michigan, Blue Cross Blue Shield of Michigan, Blue Cross Blue Shield of Michigan Inc, Blue Cross Blue Shield of Michigan Mutual Insurance Company and Blue Cross and Blue Shield of Michigan Foundation.

Blue Cross Blue Shield of Michigan jobs - 51 jobs

Senior Internal Auditor

Specialty Insurance - Senior Program Manager (AF Specialty)

Client Services Representative - Mid Shift (11:00am - 8:00pm)

Underwriting Support Specialist

Field Case Manager Los Angeles, CA Spanish CCM CDMS COHN CRRN

Risk Adjustment Coding Specialist (Remote)

Manager, Account Consultants (Remote)

Office Manager

Manager, Broker Relations (Remote)

Senior Advisor

Actuary - Pharmacy (Remote)

Small Group Sales Consultant I (Remote)

Organizational Quality Lead (Remote)

Lead Business Analyst (Remote)

Senior Systems Administrator - Ariba (Remote)

Claims Adjuster I (Remote)

Principal Data Product Manager (Remote)

Web Developer

Senior Sourcing Associate (Remote)

Sales Consultant II - New Business Development (Remote)