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Senior Assistant General Counsel - Care Delivery (Hybrid)
Carefirst, Inc. 4.8
Remote or Baltimore, MD job
Resp & Qualifications PURPOSE: The Assistant General Counsel II provides a complete range of highly specialized legal services in support of the General Counsel, Deputy General Counsel, Director, Managing Assistant General Counsel, and executive management in the Division(s) to which the Assistant General Counsel is assigned, and may represent CareFirst, Inc., its subsidiaries, and/or affiliates ("the Corporation") in litigation brought by and or against it. The Senior position is expected to work independently and provide high-level executive support. This position will support the Company's care delivery operations, including comprehensive representation of various provider entities. ESSENTIAL FUNCTIONS: Legal Advice Provides written and oral advice directly to executive management and/or their designees in complex and rapidly evolving areas of the law. Analyzes and provides legal guidance on a wide range of regulatory, contractual and operational matters, including the interpretation and implementation of legislation. Provides clear, succinct, and actionable written advice to key executive stakeholders that reflects full understanding of the pertinent operations of the Division(s) to which assigned. Renders legal guidance to counsel supporting other Divisions in specialized areas of expertise. Contract Drafting and Negotiation Provides advice and counsel to executive management and/or their designees on contractual matters, including issues arising from alliances and partnerships with, and investments in, start-up and established companies. Negotiates and draft managed care and other payor contracts to support the care delivery function. Provides strategic analysis of available alternatives and associated legal risks. Drafts, analyzes, and negotiates contracts and complex agreements involving multiple companies and significant financial resources with outside vendors. Represents the Company in disputes and/or negotiations arising from contractual relationships and/or performance. Strategic Legal Counseling Provides advice and counsel directly to executive management and/or their designees on all legal issues affecting the Companys care delivery function and operations and assists in development of business strategies within legal constraints.Provides strategic direction and guidance to Associate General Counsel and legal support staff based on corporate initiatives and allocates resources based on established priorities. Evaluates divisional initiatives and represents the Corporation's legal interests on intercompany management/executive committees. External Representation Represents the Corporation's legal interests by interfacing with opposing counsel and regulatory agencies on issues having significant impact on company operations and/or finances. Supports clients in managing communications with external parties in areas of conflict. Builds and maintains key regulatory relationships related to matters that primarily affect the Division assigned. Represents the company on legal issues arising from regulatory investigations, subpoenas, or external audits. Management and Supervision Manages the operations of the area(s) of the Legal Department assigned, including directing internal/external customers to appropriate areas of the company and/or legal department, as appropriate. Manages Associate General Counsel and/or legal support staff, including supervision of attorneys or staff, conducting performance evaluations and resolving personnel related issues, at one or more sites in addressing the needs of the Division(s) and/or in representing the corporations in legal proceedings brought by and against the Corporation. Corporate Governance Provides legal guidance to executive management regarding corporate governance issues and corporate transactional matters, including mergers, acquisitions and/or investments. May perform corporate secretarial duties for subsidiary board(s), as appropriate. QUALIFICATIONS: Education Level: Juris Doctor Licenses/Certifications: Bar Admission to the MD or DC Bar within 1 Year Required. Experience: 8 years experience as an attorney required and at least 3 years experience as a lawyer representing clients in health care, insurance, health related technology, information technology, government contracting, or related field. Candidates with fewer than the required years of experience as an attorney, but other significant experience in a legal position, may be considered. Preferred Qualifications: Demonstrated expertise in advising clients in a complex regulatory environment. Demonstrated leadership within a legal department or organization. Prior experience managing other attorneys or legal support staff. Prior experience advising provider or care delivery organizations is preferred. Knowledge, Skills and Abilities (KSAs) Experience and knowledge in the areas to be supported is essential. Strong analytical, interpersonal, and written and verbal communication skills. Ability to follow instructions, to be flexible/versatile, and to work independently. Effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging. 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: $171,760 - $307,021 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 Office of Corporate Counsel I 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 allqualified 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 #J-18808-Ljbffr
$171.8k-307k yearly 4d ago
BIA - Account Manager, Premier Client Group - HYBRID
Arbella 4.6
Remote or Fairfield, CT job
Bearingstar Insurance, a member of the Arbella Insurance Group, is one of the leading property and casualty insurance providers in Massachusetts and Connecticut writing over $100 million in premium. Bearingstar possesses a dynamic culture that has an independent agency feel along with the strength and resources of a large parent company. This allows us to offer highly competitive salaries, bonus and incentives above commission, excellent benefits, and great training and development programs. Primary Function The Account Manager's primary focus is to retain and enhance the book of business within Bearingstar's Premier Client Group and high net-worth customers through the delivery of high quality, personalized, and hands-on customer service. The Account Manager will handle the Premier Client Group across the agency's footprint, with enrolled clients affiliated with the agency's Insurance Consultants and/or any of its office locations in Connecticut and Massachusetts. This position requires the employee to act as the agency/company representative to our prospective clients, fellow professionals, public, and general business community. Key Responsibilities Account Manager plays a key role in the successful evolution of the agency's Premier Client Group, ensuring it delivers on our promise of exceptional services and offerings for all enrolled customers. Contact prospects and clients using in person, telephone and email techniques to provide professional consultative advice about recommended coverages. Prepare proposals as necessary, complete applications and calculate and quote premium rates for recommended protection, explain policy features & benefits, present options, upgrades and provide an overall analysis of protecting the customer's property & casualty exposures. Collect premium deposits and record payments. Assist in the solicitation and account management of employer based worksite marketing opportunities & related association sales activities. Counsel and provide advice to customers including, but not limited to identifying risk exposures, explaining coverages and types of policies, suggesting specific coverage enhancements, confirming recommendations in writing when appropriate and resolving general customer inquiries. Provide customer service & support within the agency on an “as needed” basis. Achieve established customer retention and sales production goals related to the acquisition of client referrals for the Personal Lines sales team and the identification of cross-sell opportunities and referrals to the agency's Life and Commercial Lines departments. Ensure new business consistent with the agency's standards for acceptable, profitable business. Update the agency management system fully to document client interactions to ensure service team fully understands what is going on with clients' portfolios, and to protect agency from errors and omissions. Properly follow established workflow and documentation standards. Follow up on suspense items in a timely manner. Become proficient with technology tools and applications to achieve the highest levels of efficiency and accuracy. Prepare regular reports detailing activities and results as requested. Maintain proper insurance licensing. Maintain positive relationships with customers and co-workers. Perform other related duties as assigned. Our candidates must be motivated, goal-oriented self-starters with excellent interpersonal and communication skills who can work alone and in a team environment. Experience working with Chubb, Pure and other high net-worth carriers is a plus. Candidates holding a MA and CT Property and Casualty license is preferred. Our current reasonable and good faith estimate of the annual salary or hourly wage range for this position is approximately $68,250 ($35.00 an hour) - $78,000 ($40.00 an hour) based on a variety of factors including, but not limited to, relevant skills and experience. Our work schedule is 37.5 hours per week. In addition, you are eligible for a profit share bonus program, exceptional benefit and wellness programs, career development, flexible schedules and much more. Please note: The advertised pay range is not a guarantee or promise of a specific wage.
$68.3k yearly Auto-Apply 52d ago
Medicare Part D Formulary Manager (Pharmacist)
Excellus BCBS 4.7
Remote or Binghamton, NY job
This pharmacist clinician is a program manager, who is responsible for all Medicare Part D formulary creation and submissions, which includes utilization management criteria development for the current and upcoming contract years. This individual creates and executes the Medicare Part D formulary, delivering value and quality to the Plan's Part D enrollees, while ensuring the longevity of the Plan's Part D program. Essential Accountabilities: Develops and maintains the Part D formulary in collaboration with strategic business partners, which include trade relations, finance, and sales to maximize savings, ensure quality, and minimize member disruption, while incorporating all CMS Part D guidance Manages all CMS Part D Formulary requirements to ensure deadlines are met. Works in conjunction with the Pharmacy Benefit Manager (PBM) and Formulary Management software vendor to execute on all formulary-related tasks. Collaborates with cross-functional management teams within the organization to align and prioritize Medicare objectives across the organization to ensure success within the framework of the Medicare STARS ranking system and deliver value to enrollees. Creates and operationalizes Medicare Part D criteria for all utilization management requirements in alignment with the Utilization Management Team. Obtains endorsement of the Medicare Part D formulary program elements from the Pharmacy and Therapeutics Committee. Oversees the production of CMS formulary model materials in partnership with Medicare Sales and Marketing. Works in conjunction with the outside vendor as needed to complete all formulary-related tasks. Supports and educates inter-departmental staff (clinicians, customer care, sales) and external customers (members, brokers) with respect to Part D formulary, utilization management edits, and CMS Part D program guidance, as appropriate. Reviews, formulates, and executes corrective action plans in conjunction with Medicare Compliance for all formulary-based findings. Supports and acts as subject matter expert for CMS formulary-based audits. Acts as a subject matter expert for clinical strategy initiatives designed to improve quality and affordability for Medicare beneficiaries. Contributes to clinical strategy initiatives within the Pharmacy Department and across the enterprise, which serve to improve quality and affordability for Medicare beneficiaries. Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies' mission and values, adhering to the Corporate Code of Conduct and leading to the Lifetime Way values and beliefs. Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures. Regular and reliable attendance is expected and required. Performs other functions as assigned by management. Minimum Qualifications: Unrestricted NYS Licensed Pharmacist. Pharm.D. In lieu of a Pharm.D., a Bachelors in Pharmacy is required with a minimum of three (3) years' experience in a managed care setting. Experience in Medicare Part D is strongly preferred. Expertise and background with Federal and state regulatory agencies (CMS, DOH, DFS, etc.) and/or accreditation agencies (NCQA, BCBSA) is preferred, but not required. Proficiency in Microsoft Excel preferred. Ability to articulate complex information in a manner that can be understood by various internal and external target audiences. Possesses the confidence to think and act differently. Demonstrates ability to thoughtfully challenge the status quo related to clinical and operational strategies and processes. Physical Requirements: Ability to work prolonged periods sitting and/or standing at a workstation and working on a computer. Ability to work while sitting and/or standing at a workstation viewing a computer and using a keyboard, mouse and/or phone for three (3) or more hours at a time. Ability to work in a home office for continuous periods of time for business continuity. Ability to travel across the Health Plan service region for meetings and/or trainings as needed. Ability to lift, carry, push, or pull 15 pounds or less. Manual dexterity including fine finger motion required. Repetitive motion required. The ability to hear, understand, and speak clearly while using a phone, with or without a headset. ************ In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position. Equal Opportunity Employer Compensation Range(s): Min: $98,297 - Max: $176,935 The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position's minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays. Please note: There may be opportunity for remote work within all jobs posted by the Excellus Talent Acquisition team. This decision is made on a case-by-case basis. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
$98.3k-176.9k yearly Auto-Apply 17d ago
Employee Relations Specialist, Hybrid
Carefirst 4.8
Remote or Baltimore, MD job
**Resp & Qualifications** This role is a Hybrid position with 10-24 days per quarter in our Baltimore City, Columbia, MD or Washington DC office. **PURPOSE:** The Employee Relations Specialist partners with employees, managers and Human Resources Business Partners to investigate and bring resolution to employee relations issues that provide fair and consistent treatment to all employees, and in a manner consistent with the company's policies, procedures, and state and federal law. **ESSENTIAL FUNCTIONS:** + Conducts basic/moderately complex HR investigations, including intake processes, investigation planning and interviews, recommendation and determination, and reporting/insights analysis. Communicates and updates status of investigations to relevant managers and HRBPs. Collects and maintains evidence, including testimonial and documentary evidence, for use in drawing investigative conclusions. Draft summary reports detailing findings resulting from investigations for review with senior staff. + Provides counsel and advice to managers and HRBPs regarding employee relations issues, submits recommendations on addressing employee relations matters and assists with taking steps in response. Analyzes employee relations and other data trends to address and mitigate risk and support and reinforce company culture. Advises employees and management on the interpretation of policies, procedures and values of the organization. + Maintains knowledge of current and emerging laws and regulations, and periodically reviews and updates applicable standards, trends and issues affecting the company work environment and policies. + Partner with senior with staff on the development of training for managers, employees, and HRBPs. **QUALIFICATIONS:** **Education Level:** Bachelor's Degree 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:** 3 years' experience addressing and resolving employee relations concerns, performance management and workplace investigations. **Salary Range:** $70,400 - $114,400 **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** Associate Relations **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-LY1 REQNUMBER: 21599
$70.4k-114.4k yearly 14d ago
Call Center Service Reps - Hybrid/Remote! Training! Benefits! Career Path! $20.50/hr
Fallon Health 4.6
Remote or Worcester, MA job
Fantastic Call Center Opportunities with training, career path advancement, great benefits, paid time off, heath insurance and more.. *The REMOTE work model can commence after approximately 8-9 weeks of on-site training in Worcester, MA. The Great Opportunity: It's an exciting time to join Fallon Health as we experience growth and expansion with new services and products. There are many great opportunities within our organization starting with joining our Member Services team. Member Services offers a very unique opportunity to interact with nearly every facet of the Fallon Health organization including our products, services, functions, and people. Among the most rewarding and fulfilling parts of working on this team is representing Fallon Health as the face of the organization; the single point of contact for our valued providers and members. Think of yourself as an Fallon brand and membership ambassador. As a representative of Fallon Health, you will be an advocate to members reaching out for support; providing this highly valued service fielding calls and constitutively troubleshooting inquiries, you will be solving their needs and concerns. In addition to the diverse responsibilities outlined below, a spot on this team also represents one of the best places to grow your career. With demonstrated initiative and strong performance, you will gain exposure across a multitude of functions and endless opportunities for advancement. Member Services has proven to be a launching pad of development that has translated into long term careers with advancement opportunities throughout the company in a number of different key area's such as; Sales and Marketing, Provider Relations, Care Services, Pharmacy and other functions of the operation. As a brand champion and valued member ambassador you will get extensive training and support through a skill based progression training program that includes a blended learning curriculum and personalized coaching plan. We are always looking for top talent in these roles so feel free to pass this along to friends, family and colleagues that you think qualify. Responsibilities Position Overview: The Member Services Representative is accountable for successfully addressing member and provider inquiries received through Fallon Health's 1-800 numbers, as well as providing direction on Plan policies, procedures, and benefits. Some key responsibilities include: Ownership for development of knowledge and skills, as training program provides material and framework for success. Ownership for customer satisfaction. Member Service Representatives are the primary liaison for our members to obtain the information or support they need As such, our representatives are expected to fully understand member/ provider needs, and within corporate/ department policies, take whatever action is necessary to fully satisfy the inquiry. Clear and concise documentation of call detail for tracking of member/ provider contacts. Identification and communication of trends that are indicative of enterprise service issues. Escalation of member/provider concerns and servicing issues. Appropriate execution of corporate and department policies/ practices. Qualifications High school diploma or GED is preferred but we would consider relevant customer service call center work experience in lieu of this. Bachelor's degree or advanced education is also preferred but not required. 2+ years professional work experience preferably in a customer facing inbound call-center setting. The ability to multitask and leverage strong typing skills and a high proficiency with MS Word, MS Excel and system data entry are essential tools for success in this role A brief web-based typing test will be sent out to applicants, and the passing score is 25 net words per minute. About Fallon Health: Founded in 1977, Fallon Health is a leading health care services organization that supports the diverse and changing needs of those we serve. In addition to offering innovative health insurance solutions and a variety of Medicaid and Medicare products, we excel in creating unique health care programs and services that provide coordinated, integrated care for seniors and individuals with complex health needs. Fallon has consistently ranked among the nation's top health plans, and is the only health plan in Massachusetts to have been awarded “Excellent” Accreditation by the National Committee for Quality Assurance for its HMO, Medicare Advantage and Medicaid products. For more information, visit ******************** Fallon Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. Pay Range Disclosure: In accordance with the Massachusetts Wage Transparency Act, the pay rate for this position is $20.50 per hour, which reflects what we reasonably and in good faith expect to pay at the time of posting. Fallon Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. #P03 Not Ready to Apply? Join our Talent Community now!
$20.5 hourly Auto-Apply 3d ago
Assistant Actuary I (Medicare)
Independence Blue Cross 4.8
Remote or Philadelphia, PA job
Bring your drive for excellence, teamwork, and customer commitment to Independence. Join us as we renew and reimagine the future of health care. Together, we will achieve our mission to enhance the health and well-being of the people and communities we serve. We are seeking an experienced Assistant Actuarial I (Medicare) professional with a strong background in Medicare pricing to join our Government Markets team. This role is ideal for candidates who have hands-on experience with Medicare Advantage and/or Part D bid development and are looking to apply their expertise in a collaborative, fast-paced environment. The successful candidate will play a key role in supporting the pricing, forecasting, and strategic analysis of our Medicare products, ensuring compliance with CMS requirements and contributing to the financial success of our government programs. Key Responsibilities: Support the development and pricing of Medicare Advantage and Part D products. Assist in preparing annual CMS bid submissions, including benefit design, cost projections, and revenue estimates. Evaluate historical claims and utilization data to support the pricing of benefit differentials and cost-sharing structures across Medicare plan designs. Collaborate with cross-functional teams, including finance, underwriting, and product development, in support of pricing analyses and corporate strategy and forecasts. Monitor regulatory changes and assess their impact on pricing and profitability. Contribute to actuarial models and tools used for bid development and scenario analysis. Present findings and recommendations to actuarial leadership and business partners. Qualifications: Bachelor's degree in Actuarial Science, Mathematics, Statistics, or a related field. 5+ years of actuarial experience, with a focus on Medicare pricing. Fellow or Associate of the Society of Actuaries (SOA). Familiarity with CMS bid process and regulatory requirements. Strong analytical and problem-solving skills. Proficiency in Excel and SQL. Excellent communication and collaboration skills. Preferred Experience: Experience with Medicare Advantage and/or Part D actuarial models. Understanding of risk adjustment and revenue forecasting. Demonstrated ability to work independently and drive projects forward with minimal oversight. Proven track record of taking initiative, managing competing priorities, and delivering high-quality work in a deadline-driven environment Hybrid: Independence has implemented a “Hybrid” model which consists of Associates working in the office 3 days a week (Tuesday, Wednesday & Thursday) and remotely 2 days a week (Monday & Friday). This role is designated as a role that fits into the “Hybrid” model. While associates may work remotely on our designated remote days, the work must be performed in the Tri-State Area of Delaware, New Jersey, or Pennsylvania. Independence Blue Cross is an Equal Opportunity and Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability. Must have an Android or iOS device which is compatible with the free Microsoft Authenticator app.
$81k-109k yearly est. 60d+ ago
Clinical Pharmacist (PA,NJ,DE)
Independence Blue Cross 4.8
Remote or Philadelphia, PA job
Job Description The Clinical Pharmacist is responsible for executing the daily activities associated with the clinical components of the pharmacy benefit. This position reviews data, resolves issues and coordinates tasks associated with pharmacy clinical programs. This position also provides clinical support to inter-disciplinary teams to improve healthcare outcomes, ensure patient safety, recommend cost-effective medication strategies, ensure compliance, and coordinate care efficiently and effectively. Responsibilities · Ensure clinically appropriate, cost-effective, and accurate formulary by providing appropriate drug review and formulary placement recommendations. · Provide support for formulary maintenance such as but not limited to member, provider, and other external communication. · Collaborate with cross-functional teams for various project work. · Ensure all regulatory guidelines are met. · Drug Information research as needed. · Serve as subject matter expert and provide recommendations designed to address Medicare Part D associated Stars ratings that may have cascading effects to other important measures such as, but not limited to, Healthcare Effectiveness Data and Information Set (HEDIS), and Consumer Assessment of Healthcare Providers and Systems (CAHPS), National Committee for Quality Assurance [NCQA] Accreditation, the Quality Rating System (Commercial Exchanges) and Health Insurance Plan Rankings · Identify underlying drivers of performance, develop and implement plans to improve ratings by working with internal departments and exploring external solutions. · Present enterprise-wide ideas into structured Part D STARS meetings and recommend provider engagement strategies by supporting populating health · Oversee monthly Acumen Patient Safety reports and track performance against industry benchmarks. Identify negative trends and communicate to key stakeholders. Ensure any outlier reports are managed and submitted to Center of Medicare & Medicaid Services (CMS) within the required timelines. · Review CMS opioid monitoring system (OMS) reports, Drug monitoring program (DMP) reports and internal reports. Oversee of DMP program and complete quarterly submissions for the OMS program. Coordinate activities with other departments such as Corporation Finance Investigation Department (CFID) and enrollment as needed. · Provide support for marketing materials related to pharmacy quality. · Serve as the subject matter expert and pharmacy liaison to the member help, population health, health coach and operations teams to facilitate the creation of job aids and training materials Required Qualifications · Doctor of Pharmacy or Bachelor of Science Degree in Pharmacy with 5 years of relevant clinical experience · Active State Pharmacy License · At least 3 years practice managed care experience or accredited Managed Care Residency · Strategic, self starter, ambitious, proactive Preferred Experience · Current knowledge and expertise in clinical pharmacology, disease management and managed care · Experience with team-based care · Self-management Skills - self-motivated, organized, detail oriented and manages time and resources effectively. Must be able to work independently in a collaborative environment, be self-directed and possess excellent organizational and time management skills · Experience with STARS, Acumen and OMS submissions · Computer/Technology Competency: Proficient in use of Microsoft Word, Excel, and Outlook Hybrid Independence has implemented a “Hybrid” model which consists of Associates working in the office 3 days a week (Tuesday, Wednesday & Thursday ) and remotely 2 days a week (Monday & Friday). This role is designated as a role that fits into the “Hybrid” model. While associates may work remotely on our designated remote days, the work must be performed in the Tri-State Area of Delaware, New Jersey or Pennsylvania IBX is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability. Must have an Android or iOS device which is compatible with the free Microsoft Authenticator app.
$110k-135k yearly est. 9d ago
Senior Sales Representative - Individual Health Policy (Remote)
Carefirst 4.8
Remote or Baltimore, MD job
**Resp & Qualifications** **CANDIDATES MUST LIVE IN THE MD, DC, NORTHERN VA AREA IN ORDER TO TRAVEL INTO THE OFFICES AND FOR CLIENT MEETINGS.** **PURPOSE:** This position is accountable for increasing enrollment, converting to, and retaining Individual ACA business. Responsible for managing strategies that support all distribution channels to build market share in the CareFirst operating area for Individual ACA plans. The incumbent serves as a subject matter expert between CareFirst and principal contracted brokers and General Agencies for marketing, sales, regulatory guidance and enrollment related to products targeting the Consumer Government Programs ACA Individual market. **ESSENTIAL FUNCTIONS:** + Establishes, develops and maintains business relationships with current and prospective brokers in the Individual ACA market segment to generate new business and retain current business, ensuring market growth goals are achieved. + Identifies broker training needs including products, eligibility, and enrollment processes and coordinates with Training division to develop training documentation to be used. Responsible for instructing brokers, General Agencies and their staff on the use of resources provided by CareFirst to assist the brokers and General Agencies with managing their business. + Support planning and engagement in outreach initiatives and public-facing events that promote awareness, drive community engagement, and organizational goals. + Keeps management informed by submitting activity and results reports, such as daily call reports, weekly work plans, and monthly report cards. + Serves as product expert and maintains an in-depth knowledge of ACA products, rules and guidelines. **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, Marketing 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:** 3 years sales experience. **Licenses/Certifications:** + Current health and life license for the jurisdictions of Maryland, DC, and Virginia Upon Hire Required. + Annual Medicare Advantage certification testing and CareFirst required Medicare Advantage product testing Required. **Preferred Qualifications:** + 3 years sales experience in Consumer sales with an emphasis in the ACA market. **Knowledge, Skills and Abilities (KSAs)** + Presentation negotiation and influencing skills, and the ability to interface with all levels of prospects and internal associates. + Understanding of broker/administrator system. + Sales motivation, compensation, knowledge of current issues in the health insurance industry. + Generating sales leads and developing external relationships to increase market value for the segment. + Significant travel, and ability to work some evenings and weekends. + Must be able to effectively work in a fast-paced environment with frequently changing priorities, deadlines, and workloads that can be variable for long periods of time. + 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. **Travel Requirements:** Significant travel required, including travel out of state. Must have a valid driver's license and transportation to travel throughout service area. Salary Range: $53,600 - $87,100 **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 Sales **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: 21366
$53.6k-87.1k yearly 60d+ ago
Director & Actuary
Independence Blue Cross 4.8
Remote or Philadelphia, PA job
Bring your drive for excellence, teamwork, and customer commitment to Independence. Join us as we renew and reimagine the future of health care. Together, we will achieve our mission to enhance the health and well-being of the people and communities we serve. The Director & Actuary Commercial Pricing leads the development and execution of pricing strategies for the organization's commercial health insurance products, including fully insured and self-funded plans across small group, large group, and level-funded markets. This role is responsible for ensuring rate adequacy, competitiveness, and compliance with regulatory requirements, while supporting growth and profitability objectives. The position reports to the Director & Actuary Commercial Markets Key Responsibilities: Lead pricing strategy and rate development for commercial products, including medical and ancillary benefits. Collaborate with underwriting, product, sales, and finance teams to align pricing with market dynamics and business goals. Monitor and analyze utilization and unit cost trends, working with others in the Actuarial team; recommend pricing adjustments based on emerging experience. Ensure compliance with state and federal rate filing requirements; support DOI interactions and respond to regulatory inquiries. Oversees and reviews the development and maintenance of actuarial tools and models to support pricing decisions and financial projections. Provide leadership and mentorship to actuarial analysts and managers; foster a culture of analytical rigor and innovation. Present pricing strategy and performance insights to leadership and cross-functional stakeholders Qualifications: ASA or FSA designation with 8+ years of actuarial experience in commercial health insurance. Deep understanding of healthcare cost drivers, benefit design, and risk adjustment methodologies. Proven experience with ACA, level-funded, and large group pricing. Strong analytical and communication skills; ability to translate complex data into actionable insights. Proficiency in actuarial software (e.g., SQL, SAS, R, Excel, Python) and data visualization tools. Experience managing teams and cross-functional projects. Independence has implemented a “Hybrid” model which consists of Associates working in the office 3 days a week (Tuesday, Wednesday & Thursday) and remotely 2 days a week (Monday & Friday). This role is designated as a role that fits into the “Hybrid” model. While associates may work remotely on our designated remote days, the work must be performed in the Tri-State Area of Delaware, New Jersey, or Pennsylvania. IBX is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability. Must have an Android or iOS device which is compatible with the free Microsoft Authenticator app.
$87k-113k yearly est. 60d+ ago
Auditor II
Bluecross Blueshield of South Carolina 4.6
Remote or Nashville, IL job
The Auditor II is a full-time remote position working 8:00-5:00 p.m.What You'll Do: Conducts internal and external timely operational, compliance, and financial audits of divisions, departments, providers, and activities of the corporation including evaluation of internal controls. Identifies, documents, and evaluates business risks. Documents issues, the causes of those issues, and their effects on the process/function and the corporation. Drafts recommendations to limit risks and improve processes, functions and activities. Writes audit reports for corporate executive management that clearly and effectively convey engagement evaluations, conclusions, and recommendations. Collects and analyzes data to detect deficient controls, duplicated effort, fraud, or non-compliance with laws, regulations, and management policies. Conducts testing of corrective actions as identified. Develops detailed reports on each audit conducted. Reports include a review of findings and an identification of recommendation to correct any deficiencies and methods for improvement to processes. Examines and evaluates financial and information systems, recommending controls to ensure system reliability and data integrity. Conducts special audit studies for management, such as those required to discover controls for prevention of fraud. Prepares reports of findings and recommendations for management. Assists other auditors in completing their assignments as a means of maximizing audit efficiency and thus reducing lost time and involvement of corporate personnel. Required Education: Bachelor's degree - Accounting , Finance, Business Administration, or other job related field of study.Required Work Experience: 3 years auditing experience.Required Skills and Abilities: Knowledge of the principles and practices of auditing. Ability to analyze and determine the applicability of financial data. Ability to draw conclusions and make appropriate recommendations for analyzed data. Ability to gather information by examining records and documents and interviewing individuals. Strong interpersonal skills. Ability to maintain effective working relationships. Ability to communicate clearly and effectively in oral and written form. Ability to handle sensitive matters on a confidential basis. Required Software and Tools: Microsoft Office.Preferred Licenses and Certificates: Certified Internal Auditor (CIA) or Certified Public Accountant (CPA) or Certified Information Systems Auditor (CISA) Work Environment: Typical office environment. Travel between office buildings may be required. Out of town travel may be required.What We Can Do for You: We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company.What To Expect Next: After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements.Salary Range: Range Minimum $51,107.00 Range Midpoint $74,418.00 Range Maximum $97,729.00Equal Employment Opportunity StatementBlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company.If you need special assistance or an accommodation while seeking employment, please email ************************ or call ************, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.Here's more information.Some states have required notifications. Here's more information. Equal Employment Opportunity Statement BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations. We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company. If you need special assistance or an accommodation while seeking employment, please email ************************ or call ************, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis. We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here's more information. Some states have required notifications. Here's more information.
$51.1k-97.7k yearly Auto-Apply 6d ago
Provider Relations Manager (Hybrid)
Carefirst 4.8
Remote or Baltimore, MD job
**Resp & Qualifications** _We are looking for an experienced professional in the greater Baltimore/Washington metropolitan area who is willing and able to work in a hybrid model. The incumbent will be expected to work a portion of their week from home and a portion of their week at a CareFirst location based on business needs and work activities/deliverables that week._ **PURPOSE:** Responsible for the daily management, coaching, and development of the Provider Relations team including oversight of department operations, promoting quality service, strengthening relationships through proactive training, education, communication, and ensuring complex problem resolution to all network providers in Maryland, DC, Northern Virginia and continuous counties. **ESSENTIAL FUNCTIONS:** + Responsible for improving provider experience; anticipates provider issues and develops a plan to reduce concerns through better alternatives; responsible for issue resolution and escalation as appropriate; sets goals for and work closely with the team to drive performance to ensure provider experience metrics are met or exceeded + Provides direction and guidance to staff to explain and coordinate administrative process and needs; coaches and trains direct reports to ensure a competent and effective workforce with the necessary skills and competencies to provide quality service to both internal and external customers & performs all management duties including hiring, goal setting and monitoring, performance review, budget review, coaching and development of associates, one-on-one meeting, conflict resolution, etc. + Implements ongoing provider education initiatives within area of accountability; seeks to proactively improve level of education over time + Responsible for representing Networks Management/Provider Relations in a variety of work groups to support divisional and corporate level initiatives. + Collaborates with a variety of stakeholders within and outside of the division by managing key initiatives and projects; builds and maintains a solid professional relationship with key personnel representing provider from office worker to managed care executive & manages relationships with external associations including medical societies, Maryland Hospital Association (MHA), American Association of Hospital Administrator Management (AHAM), medical specialty associations, etc. **SUPERVISORY RESPONSIBILITY:** This position manages people. **QUALIFICATIONS:** **Education Level:** Bachelor's Degree in 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 healthcare claims and/or service experience. 1 year supervisory experience or demonstrated progressive leadership experience. **Preferred Qualifications:** + Advanced degree as evidenced by MBA & knowledge of CareFirst provider relations systems, processes and contracts. + Experience working with healthcare providers, ideally in a payer setting. **Knowledge, Skills and Abilities (KSAs)** + Strong interpersonal skills. Ability to work independently, as well as a member of a team. + Strong critical reasoning skills in clinical decision-making, planning and organizing. + Working knowledge of provider community, provider reimbursement, medical terminology, CPT coding and CMS 1500 or CMS 04. + Ability to determine priorities and meet deadlines. + Strong customer service skills. + Proven effective written and interpersonal communication skills, well organized, ability to multi-task and work independently, promote flexibility and teamwork Strong PC skills with experience using Microsoft Office applications. + Strong problem-solving ability, critical thinking, and analytical skills. + Ability to train and mentor staff. + 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:** $92,320 - $171,369 **Travel Requirements** **Estimate Amount:** 30% In normal environment, expected to regularly meet with providers in person at their practice or other central location **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** Provider Relations and Education **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: 21637
$92.3k-171.4k yearly 2d ago
Software Engineer II (hybrid)
Grange Insurance Careers 4.4
Remote or Columbus, OH job
If you're excited about this role but don't meet every qualification, we still encourage you to apply! At Grange, we value growth and are committed to supporting continuous learning and skill development as you advance in your career with us. Summary: This position is responsible for writing accurate and efficient program code, updating and expanding existing programs, debugging existing programs, and testing software with both manual and automated unit testing approaches. What You'll Be Doing: Proficient in development technologies (Java/GOSU) utilized by their team with accelerating delivery results. Able to work independently with analyst and test engineering to move application changes through all stages of development. Support maintenance and modification of applications as directed. Demonstrate ability to learn system architecture as it relates to project work. Follow best practices regarding all technical and design standards for their application. Take ownership of their work and quickly address technical or quality issues. Submit code for peer reviews and may actively participate in peer reviews of others. Demonstrate a desire to participate in peer-to-peer coaching and mentoring. Display a level of influence within their immediate team. Display innovative thinking. Ability to communicate with business partners in a clear and concise manner regarding their current work. Leverage new technologies like Gen AI to be more effective and efficient in completing deliverables. What You'll Bring To The Company: 2+ years of development experience preferred (ideal candidate will have billing center/Guidewire development experience) Demonstrate proficiency in learning and using multiple development languages. Demonstrate a working knowledge of artificial intelligence technologies Excellent organizational skills, with proven analytical, planning, problem solving and decision-making skills. About Us: Grange Insurance Company, with $3.2 billion in assets and more than $1.5 billion in annual revenue, is an insurance provider founded in 1935 and based in Columbus, Ohio. Through its network of independent agents, Grange offers auto, home and business insurance protection. Grange Insurance Company and its affiliates serve policyholders in Georgia, Illinois, Indiana, Iowa, Kentucky, Michigan, Minnesota, Ohio, Pennsylvania, South Carolina, Tennessee, Virginia, and Wisconsin and holds an A.M. Best rating of "A" (Excellent). Grange understands that life requires flexibility. We promote geographical diversity, allowing hybrid and remote options and flexibility in work hours (role dependent). In addition to competitive traditional benefits, Grange has also created unique benefits based on employee feedback, including a cultural appreciation holiday, family formation benefits, compassionate care leave, and expanded categories of bereavement leave. Who We Are: We are committed to an inclusive work environment that welcomes and values diversity, equity and inclusion. We hire great talent from various backgrounds, and our associates are our biggest strength.â¯We seek individuals that represent the diversity of our communities, including those of all abilities. A diverse workforce's collective ideas, opinions and creativity are necessary to deliver the innovative solutions and service our agency partners and customers need. Our core values: Be One Team, Deliver Excellence, Communicate Openly, Do the Right Thing, and Solve Creatively for Tomorrow. Our Associate Resource Groups help us create a more diverse and inclusive mindset and workplace. They also offer professional and personal growth opportunities. These voluntary groups are open to all associates and have formed to celebrate similarities of ethnicity/race, nationality, generation, gender identity, and sexual orientation and include Multicultural Professional Network, Pride Partnership & Allies, Women's Group, and Young Professionals. Our Inclusive Culture Council, created in 2016, is focused on professional development, networking, business value and community outreach, all of which encourage and facilitate an environment that fosters learning, innovation, and growth.â¯Together, we use our individual experiences to learn from one another and grow as professionals and as people.â¯ We are committed to maintaining a discrimination-free workplace in all aspects, terms and conditions of employment and welcome the unique contributions that you bring from education, opinions, culture, beliefs, race, color, religion, age, sex, national origin, handicap, disability, sexual orientation, gender identity or expression, ancestry, pregnancy, veteran status, and citizenship.
$65k-84k yearly est. 60d+ ago
Senior Underwriter
Independence Blue Cross 4.8
Remote or Philadelphia, PA job
Bring your drive for excellence, teamwork, and customer commitment to Independence. Join us as we renew and reimagine the future of health care. Together, we will achieve our mission to enhance the health and well-being of the people and communities we serve. Senior Underwriter Responsibilities: Prepares and reviews cases and employs various underwriting risk assessment techniques depending on the appropriate approach for the specific customer. Establishes supporting documentation for analysis and makes recommendations and/or pricing decisions internally to underwriting management and/or sales based on established authority level. Assists more junior underwriters in meeting department needs and developing skills. Attends and often co-leads internal, customer and broker dialogues in order to provide consultative support and recommendations based on the client specific considerations. May participate on multi-department projects. Has a strong knowledge of Health Care Reform, risk assessment, marketplace conditions, competitive landscape, and relevant business acumen. May underwrite medical, pharmacy, and/or ancillary lines of business. Completes RFP's and RFR's for assigned cases. Knowledge, Skills and Abilities Advanced knowledge of medical insurance concepts, underwriting, rating techniques and risk evaluation is required. The ability to work independently and manage multiple priorities under tight timeframes. Strong analytical and mathematical skills as well as the ability to recognize, research and resolve discrepancies then effectively communicate results and recommendations is required. Exhibits a prescribed level of proficiency across all competencies as defined in the Underwriting Competency Model. In addition, each role within Underwriting has five specific competencies that are weighted heavier in the evaluation of performance. Must be detail oriented, skilled in problem solving, mathematics and algabraic concepts. In depth understanding of insurance concepts, and advanced understanding of rating techniques. Must have advanced interpersonal skills, including written and verbal communication. Knowledge of the Microsoft office suite of products (Access, Word and Excel), in depth understanding of underwriting technology and support systems. Qualifications - External Minimum of 5 years progressive experience working in group medical insurance environment and 3+ years experience working in underwriting environment. Can be concurrent experience. Bachelor's degree or equivalent experience required. MBA preferred. Independence has implemented a “Hybrid” model which consists of Associates working in the office 3 days a week (Tuesday, Wednesday & Thursday) and remotely 2 days a week (Monday & Friday). This role is designated as a role that fits into the “Hybrid” model. While associates may work remotely on our designated remote days, the work must be performed in the Tri-State Area of Delaware, New Jersey, or Pennsylvania. IBX is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability. Must have an Android or iOS device which is compatible with the free Microsoft Authenticator app.
$60k-85k yearly est. 7d ago
Head of Underwriting - Equine Division
Great American Insurance Group (DBA 4.7
Remote or Ocala, FL job
Be Here. Be Great. Working for a leader in the insurance industry means opportunity for you. Great American Insurance Group's member companies are subsidiaries of American Financial Group. We combine a "small company" culture where your ideas will be heard with "big company" expertise to help you succeed. With over 30 specialty and property and casualty operations, there are always opportunities here to learn and grow. At Great American, we value and recognize the benefits derived when people with different backgrounds and experiences work together to achieve business results. Our goal is to create a workplace where all employees feel included, empowered, and enabled to perform at their best. Great American's Equine Mortality Division is one of the world's leading providers of equine mortality insurance and related coverages. The division is staffed with experts in all breeds and disciplines such as racing, showing, cutting, dressage, hunter/jumper, driving, reining, and pleasure riding. The Equine Division is currently searching for a Head of Underwriting/Officer Level leader to manage our Underwriting team in Ocala, FL. This office follows a hybrid schedule (3 days in office, 2 days work from home). Responsibilities: * Provides leadership, coaching and direction to the underwriting team to ensure growth and profitability. * Identifies opportunities to develop new business. * Ensures the Equine book of business meets budget and performance targets. * Develops and maintains strong relationships with brokers and agents by providing excellent customer service in order to attract and retain profitable business. * Has accountability for the risk selection / rejection, pricing, retention, growth and profitability (within scope of authority and per divisional objectives). * Oversees receipt and analysis of submissions and decisions of what terms to offer (policy limits, credit limits, deductibles, coverage options and conditions, etc.). * Works with Predictive Analytics to ensure business is priced in accordance with company guidelines. * Approve and monitor underwriting guidelines, rules, practices and systems necessary to maintain and develop profitable commercial lines business * Works with other functional units within the division to identify goals and strategies to optimize customer service and satisfaction. * Ensures the appropriate utilization of underwriting and desktop systems. * Assesses risk quality and compliance within company guidelines and may initiate appropriate loss prevention actions. * Performs other duties as assigned. Qualifications: * Bachelor's Degree or equivalent experience * Generally, 10-15 years of experience in underwriting * Previous management experience is strongly preferred * Strong agent and broker relationships * Must have strong organizational and analytical skills, as well as the ability to multi-task * Ability to travel 20%, including overnight * Ability to relocate/commute to Ocala, FL Business Unit: Equine Mortality Benefits: Compensation varies by role, position level, and location. Individual pay is influenced by skills, education, training, certifications, experience, and the role's scope and complexity, along with business needs. We offer a competitive Total Rewards package, including medical, dental, and vision plans starting on day one, PTO, paid holidays, commuter benefits, an employee stock purchase plan, education reimbursement, paid parental leave/adoption assistance, and a 401(k) plan with company match. These benefits are available to eligible full-time and part-time employees. Your recruiter can provide more details about our total rewards and specific compensation ranges during the hiring process.
$54k-94k yearly est. Auto-Apply 44d 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
Vacant job positions: Insurance Product Management Analyst- Senior (Personal Lines) Remote
Mapfre 4.6
Remote job
**Please note this role is not eligible for sponsorship now or in the future** We're looking for a highly analytical, business-minded Product Analyst to join our Personal Lines Product Management team. This role is ideal for someone who enjoys solving complex problems, working with data to tell a compelling story, and partnering closely with Product Managers, Actuarial, Marketing, Underwriting, and Operations to drive profitable growth. You will play a critical role in supporting product strategy, performance analytics, and rate/underwriting enhancements across our auto and property insurance portfolio. This is a high-visibility opportunity to influence decision-making and help shape the future of our products. Responsibilities: Shares responsibility for top and bottom-line results for assigned state(s). Conducts thorough analysis and assessment of product and business performance using internal and external data sources to identify opportunities to improve KPIs and profitable growth. Develop hypothesis-driven analytics and test/learn frameworks. Build dashboards and performance reports that inform pricing, underwriting, and product decisions. Present findings and recommendations in a clear and concise manner. Support rate and product reviews, competitor analyses, and market research across multiple states and product lines. Lead assigned rate/rule/form filings and implementations to meet an established filing schedule. Build comprehensive business requirements that will be used by the IT Department. Work with the IT Department to ensure timely and accurate implementation of product changes. Assumes additional responsibilities as assigned. Qualifications: Bachelor's Degree or professional level of knowledge in a specialized field, or equivalent, related experience. 2+ years relevant experience required. Strong mathematical aptitude and analytical skills required. Quantitative and qualitative analysis and critical thinking skills. Knowledge of Excel and SAS, SQL, and/or other large dataset analysis tools. Attention to detail with ability to manage multiple tasks/priorities while working in a fast-paced environment with limited supervision. Why MAPFRE? At MAPFRE, we're more than an insurance company-we're a global leader committed to innovation, customer satisfaction, and employee growth. Joining MAPFRE means: Impactful Work: Your insights will directly shape product strategy and influence decisions that drive profitable growth. Collaborative Culture: Work alongside talented professionals in Product Management, Actuarial, Marketing, Underwriting, and Operations. Professional Development: We invest in your success with training, mentorship, and opportunities for advancement. Stability & Global Reach: Be part of a trusted brand with a strong presence in over 40 countries. Commitment to Innovation: Help us transform the insurance industry through data-driven solutions and cutting-edge technology. Pay Philosophy: The typical starting salary range for this role is determined by several factors including skills, experience, education, certifications, and location. Some roles at MAPFRE are eligible for commission and/or bonus earnings, in addition to salary, calculated based upon factors set forth in the compensation plan for the role. Salary Range $80,000 - $119,000 Thank you for considering MAPFRE Insurance as part of your career journey. We're proud to be rated "A" (Excellent) by A.M. Best Company. We offer property and casualty insurance, working with over 3,000 independent agents and brokers in 11 states. If you require an accommodation for a disability so that you may participate in the selection process, you are encouraged to contact the MAPFRE Insurance Talent Acquisition team at *******************************. We are proud to be an equal opportunity employer.
$80k-119k yearly Easy Apply 24d ago
Medical Director, Psychiatry (SafetyNet & Behavioral Health)
Excellus Health Plan 4.7
Remote or Buffalo, NY job
This position assists the Chief Medical Director to direct and coordinate the medical management, quality improvement and credentialing functions for the business unit. This a flexible hybrid/remote role! Essential Accountabilities: Level I Provides medical leadership of all for utilization management, cost containment, and medical quality improvement activities. Performs medical review activities pertaining to utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services. Supports effective implementation of performance improvement initiatives for capitated providers. Assists Chief Medical Director in planning and establishing goals and policies to improve quality and cost-effectiveness of care and service for members. Provides medical expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory, state, corporate, and accreditation requirements. Assists the Chief Medical Director in the functioning of the physician committees including committee structure, processes, and membership. Oversees the activities of physician advisors. Utilizes the services of medical and pharmacy consultants for reviewing complex cases and medical necessity appeals. Participates in provider network development and new market expansion as appropriate. Assists in the development and implementation of physician education with respect to clinical issues and policies. Identifies utilization review studies and evaluates adverse trends in utilization of medical services, unusual provider practice patterns, and adequacy of benefit/payment components. Identifies clinical quality improvement studies to assist in reducing unwarranted variation in clinical practice in order to improve the quality and cost of care. Interfaces with physicians and other providers in order to facilitate implementation of recommendations to providers that would improve utilization and health care quality. Reviews claims involving complex, controversial, or unusual or new services in order to determine medical necessity and appropriate payment. Develops alliances with the provider community through the development and implementation of the medical management programs. May represent the business unit before various publics both locally and nationally on medical philosophy, policies, and related issues, as needed. Represents the business unit at appropriate state committees and other ad hoc committees Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies' mission and values and adhering to the Corporate Code of Conduct. Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures. Conducts periodic staff meetings to include timely distribution and education related to departmental and Ethics/Compliance information. Regular and reliable attendance is expected and required. Performs other functions as assigned by management. Level II (in addition to Level I Accountabilities) Reviews medical literature and applies evidence-based principles using high proficiency skills for a broad range of clinical services. Reviews internal trend reports to assess present and future needs and opportunities. Interacts with regulatory and accreditation agencies as assigned. Provides clinical support to the Sales and Marketing divisions Provides clinical leadership for the implementation of new utilization/case/quality management initiatives Minimum Qualifications: Level I New York State licensed physician. Minimum 7 years of experience in a BH managed care settings or BH clinical setting (at least 2 of which are in a clinical setting). This experience begins at the conclusion of any residency and/or fellowship training. Board certification in general psychiatry or certification in addiction medicine or certification in the subspecialty of addiction psychiatry. Appropriate training and expertise in general psychiatry and/or addiction disorders. Ability to identify, analyze and resolve complex medical issues. Skills in evidence-based medicine. Strong interpersonal skills essential for communication to staff at all levels of the organization., Basic skill sets in electronic communication systems such as e-mail and Word. Level II (in addition to Level I Minimum Qualifications) Superior evidence-based medicine skill set Strong interpersonal skills essential for communication to physicians in the community. Strong verbal presentation skills to lead internal and external discussions at board levels Advanced skill sets in electronic communication systems such as e-mail, Word, PowerPoint, and Excel. Physical Requirements: Ability to work prolonged periods sitting at a workstation and working on a computer. Ability to work while sitting and/or standing while at a workstation viewing a computer and using a keyboard, mouse and/or phone for three (3) or more hours at a time. Typical office environment including fluorescent lighting. Ability to work in a home office for continuous periods of time for business continuity. Ability to travel across the Health Plan service region for meetings and/or trainings as needed. Ability to lift, carry, push or pull 15 pounds or less. Manual dexterity including fine finger motion required. Repetitive motion required. The ability to hear, understand and speak clearly while using a phone, with or without a headset. ************ In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position. Equal Opportunity Employer Compensation Range(s): Min: $202,000 - Max: $303,000 The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position's minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays. Please note: There may be opportunity for remote work within all jobs posted by the Excellus Talent Acquisition team. This decision is made on a case-by-case basis. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
$202k-303k yearly Auto-Apply 46d ago
Claims PL Casualty Medical Representative (remote)
Grange Insurance Careers 4.4
Remote job
If you're excited about this role but don't meet every qualification, we still encourage you to apply! At Grange, we value growth and are committed to supporting continuous learning and skill development as you advance in your career with us. Summary: This position is responsible for investigating, evaluating and negotiating settlement of assigned Medical Payments claims with the goal of serving the customer and ensuring quality file handling. What You'll Be Doing: Pursuant to Company line of business strategies and good faith claim settlement practices: investigates, evaluates, negotiates and settles (within authorized limits) assigned Medical Payment coverage claims. Establishes and maintains positive relationships with both internal and external customers providing excellent customer service. Review and analysis of medical claims including, but not limited to, the analysis and interpretation of medical records and reports. Reviews medical bills for accuracy and reasonableness, utilizing independent discretion, bill review software and established best practices. What You'll Bring To The Company: High school diploma or equivalent education and experience required plus three years related experience preferred. Bachelor's degree in related field preferred. Must possess strong communication and organization skills and ability to work with personal computer. Must be able to work both independently and within a team environment using sound judgment in decision-making. Able to work well under deadlines in a changing environment and perform multiple tasks effectively and concurrently. Demonstrated ability to interact with people in a professional manner, determine coverage, investigate and determine liability needed. State specific adjusters' license may be required.
$35k-42k yearly est. 7d ago
Claims Specialist - Bodily Injury
Great American Insurance Group (DBA 4.7
Remote or Ohio, IL job
National Interstate is a member of Great American Insurance Group. As one of the leading commercial transportation insurers in the nation, we offer risk financing solutions in all 50 states tailored to meet the needs of a wide variety of transportation classes. Our offerings include traditional insurance and innovative alternative risk transfer (ART) programs, including more than a dozen group captive programs catering to niche wheels markets. We are proud to be a multiple Northcoast 99 winner and Cleveland Plain Dealer Top Workplace in Northeast Ohio. It is because of our talented and dedicated team that we are able to live out our company values of integrity, transparency, fairness, accountability, empowerment and collaboration with each transaction we make. If you are ready to join an engaging and driven team such as ours, we would love to hear from you! At Great American, we value and recognize the benefits derived when people with different backgrounds and experiences work together to achieve business results. Our goal is to create a workplace where all employees feel included, empowered, and enabled to perform at their best. Since 1989, National Interstate has specialized in serving the insurance needs of the wheels-based transportation industry. Our steadfast focus on developing niche expertise in product design, loss control and claim services has made National Interstate one of the most respected names in commercial transportation insurance today. (****************** National Interstate is looking for a Claims Specialist to join their team. This individual will work fully remote from the USA. Essential Job Functions and Responsibilities * Manages a large inventory of complex claims to evaluate compensability/liability. * Plans and conducts complex claims investigations to confirm coverage and to determine liability, compensability and damages. * Analyzes and negotiates appropriate claim settlements/reserves within prescribed authority. May attend arbitrations, mediations, depositions, or trials. * Conveys complex information regarding coverage and settlements to insureds, claimants, and external partners. * Authorizes payments in accordance with assigned authority limit and ensures payments are made in a timely manner. * Maintains accurate and detailed claim files, including all correspondence, reports, and settlement agreements. * May have responsibility for performance and coaching of staff and may have a participatory role in decisions regarding talent selection, development, and performance management for direct reports. * Performs other duties as assigned. Job Requirements Education: Bachelor's Degree in Business Administration, Risk Management and Insurance, Finance, or a related field or equivalent experience. Experience: Generally, a minimum of 9 years of experience in property and casualty claims handling. Completion of or continuing progress toward a professional designation preferred, such as Associate in Claims (AIC). Scope of Job/Qualifications: Works within broad limits and authority on assignments of the highest technical complexity, requiring specialized knowledge. Demonstrates excellent analytical, negotiation, and problem-solving skills. Maintains strong knowledge of insurance policies, coverage, and claims handling procedures. Maintains knowledge of industry laws and regulations. Advanced ability to organize and prioritize caseloads, ensuring timely resolution of claims. Excellent interpersonal and communication skills with the ability to build relationships and lead negotiations. Proven ability to handle confidential information with discretion. Viewed as a senior resource within the Claims department and/or organization. Company: NIIC National Interstate Insurance Company Salary Range: $90,000.00 -$100,000.00 Benefits: Compensation varies by role, position level, and location. Individual pay is influenced by skills, education, training, certifications, experience, and the role's scope and complexity, along with business needs. We offer a competitive Total Rewards package, including medical, dental, and vision plans starting on day one, PTO, paid holidays, commuter benefits, an employee stock purchase plan, education reimbursement, paid parental leave/adoption assistance, and a 401(k) plan with company match. These benefits are available to eligible full-time and part-time employees. Your recruiter can provide more details about our total rewards and specific compensation ranges during the hiring process.
$90k-100k yearly Auto-Apply 60d+ 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

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Updated December 25, 2025

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CDPHP may also be known as or be related to CAPITAL DISTRICT PHYSICIANS' HEALTH, CDPHP, CDPHP Universal Benefits Inc and Cdphp.

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