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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 3d ago

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Senior Production Underwriting Specialist - Excess Casualty
Great American Insurance Group 4.7
Remote or Dallas, TX 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 diversity and recognize the benefits gained when people from different cultures, backgrounds and experiences work collaboratively to achieve business results. We are intentionally focused on fostering an inclusive culture and know valuing diversity is an essential leadership quality. Our goal is to create a workplace where all employees feel included, empowered and enabled to perform at their best. The Excess Liability Division specializes in offering large limits of liability to protect its clients' corporate assets from catastrophic loss. The Division offers significant capacity of up to $20 million dollars for both Lead Umbrella and Excess Liability placements. This protection is made available to companies varying in size from single location light hazard risks to a wide variety of more difficult to place manufacturers and processors. ************************************************************************************************** The Excess Liability Division is currently searching for a Senior Production Underwriting Specialist or an AVP of Underwriting to join our Excess Liability team. This individual will work a hybrid schedule (4 days in office, 1 day WFH) out of the Dallas, TX office OR fully remote if they reside outside of the Dallas area. We are open to candidates who reside in Texas, Oklahoma, or Mississippi. The underwriter will primarily be handling Lead Umbrella and Excess Liability risks in manufacturing, contracting, retail service and distribution. The business unit strategically solicits Middle Market to National commercial risks from a producer base that spans the United States. Essential Job Functions and Responsibilities Responsible for leading the evaluation and underwriting of new and renewal business, ensuring alignment with Company underwriting guidelines and risk appetite. Analyzes and evaluates complex risk data to make informed decisions on coverage, pricing, and terms. Fosters strategic partnerships with claims, agents, brokers, and clients to obtain necessary information and provide guidance. Procures and analyzes supplementary reports and screenings, such as Safer-SMS reports, loss history reports, and external inspections, to support underwriting decisions. Ensures proper documentation of underwriting decisions and compliance with state and federal insurance regulations. Evaluates complex policy renewals and modifications, identifying opportunities for policy enhancements and risk mitigation. Communicates underwriting strategies and decisions effectively to internal teams, agents, and brokers. Monitors and shares insights on industry trends, regulatory changes, and market conditions. Maintains effective business relationships with internal and external customers/coworkers, focusing on generating new business and retaining profitable business. Responsible for explaining and promoting products and services to drive market growth. Oversees the development and execution of comprehensive marketing strategies to effectively promote the company's products to brokers and agents. Analyzes market trends and competitive landscape to identify strategic opportunities and makes recommendations for product enhancements and innovative marketing approaches. Responsible for leading marketing initiatives, including presentations, industry events, and broker/agent meetings, to showcase the company's products and services. Responsible for evaluating underwriting and marketing practices, implementing strategic adjustments to improve overall effectiveness and outcomes. 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 Bachelor's Degree or equivalent experience. Generally, a minimum of 13 years of experience in Underwriting or a related field. Excess and umbrella underwriting experience preferred. Completion of or continuing progress toward a professional designation preferred. Effective communication and negotiation skills to build and leverage excellent customer relationships and to successfully market products and services. Position requires frequent day and overnight travel, more than 10% but less than 50% of time to visits agents and brokers.
$47k-67k yearly est. 4d ago
Customer Service
Bluecross Blueshield of Vermont 4.6
Remote or Berlin, VT job
Blue Cross and Blue Shield of Vermont is looking for a Customer Service Representative to join our Federal Employment Program team. Our company culture is built on an unwavering focus on our members and giving them the best service possible. We offer a balanced, flexible workplace, an onsite gym, fitness and wellness programs, a competitive salary and full benefits package including medical and dental insurance, vision, 401k, paid time off and holidays, tuition reimbursement and student loan repayment, dependent caregiver benefits, and resources to support your ongoing personal and professional growth and development. COMPENSATION: The hourly wage for this position is $18.00/hour. Additional compensation opportunities and incentives will be detailed during the interview process. Please note that this wage listed is our good faith estimate for this role. We also offer a robust benefits package with significant value (see below). LOCATION : Blue Cross has transitioned to a hybrid workplace where employees within driving distance of our Berlin, VT office work Wednesdays in the office with flexibility to work remotely the rest of the week. Customer Service Representative Responsibilities: Complete a program comprised of classroom and on-the-job training that will provide the technical knowledge and customer service skills needed to accurately answer most member and provider questions. Learn and utilize customer service skills in order to successfully handle all customer interactions in a consistent, courteous, and professional manner. Accurately document, track, and research all inquiries in Customer Focus (CF) according to department guidelines and written procedures. Achieve a level of call volume and quality goals as set forth in the Customer Service Career Pathing Guidelines. Successful achievement of these goals will help enable to CSR to transition to a Customer Service Representative II position. Customer Service Representative Qualifications: High school graduate or equivalent required. Analytical and critical thinking skills required. Computer literacy, strong typing and spelling skills required. One to two years of successful customer service experience, preferably in a health insurance or health care setting is desired. The ability to multitask, problem solve and work independently is necessary. Customer Service Representative Benefits: Health insurance (including vision) Dental coverage (free to employees) Wellness Program 401(k) with employer match + automatic employer contribution Life Insurance Disability Insurance Combined time off (CTO) - 20 days per year + 10 paid holidays Tuition Reimbursement Student Loan Repayment Dependent Caregiver Benefits Diversity, Equity, and Inclusion: Blue Cross VT is committed to creating an inclusive environment where employees respect, appreciate, and value individual differences, both among ourselves and in our communities. We welcome applicants from all backgrounds and experiences to join us in our commitment to the health of Vermonters, outstanding member experiences, and responsible cost management for all the people whose lives we touch. Learn more about our DE&I commitment at **************************************************************** *Full job description attached to ADP job posting.
$18 hourly Auto-Apply 11d ago
Consultant, Sr Provider Education
Bluecross Blueshield of South Carolina 4.6
Remote or South Carolina job
Logistics: Palmetto GBA,- one of BlueCross BlueShield's South Carolina subsidiary companies. Government Clearance: This position requires the ability to obtain a security clearance, which requires applicants to be a U.S. Citizen. Location: This a full-time remote position. You will work an 8-hour shift scheduled during our normal business hours of 8:00 a.m.-5:00 p.m. Monday - Friday. It may be necessary, given the business need to work occasional overtime. What You'll Do: Communicates/educates providers on issues such as Medicare coverage, utilization statistics, documentation and medical review by use of written advisories, reports, letters, and telephone contacts. Documents all provider contacts/communications in provider tracking system. Conducts formal conference calls and/or in-person educational visits with providers that are consistently over utilizing services, on progressive corrective action, or have unacceptable denial rates and/or error rates under the medical review program. Conducts coverage and documentation workshops for provider staff (Medicare providers and physicians' staff). Researches, composes, and coordinates the preparation of all regulatory based provider education materials. Performs analysis of effective reports to determine actions to be taken regarding medical reviewed its/audits. Determines what providers are over-utilizing services and what services are being over-utilized. Works with medical review department and provides input regarding actions taken in response to provider billing practices. Targets providers where greatest abuse of Medicare program has occurred. Participates in the medical review process and inter reviewer reliability (IRR) studies. Assists in training of medical review associates regarding coverage and medical review process. To Qualify for This Position, You'll Need the Following: Required Education: If LPN, graduate of accredited School of Licensed Practical Nursing; if LVN, graduate of accredited School of Licensed Vocational Nursing; if RN, graduate of approved School of Nursing. Required Experience: If LPN or LVN, 7 years of clinical experience or equivalent combination of clinical and educator experience. If RN, 5 years of clinical experience or equivalent combination of clinical and educator experience. Required Software and tools: Microsoft Office. Required Skills and Abilities: Knowledge of medical terminology and disease processes. Demonstrated proficiency in word processing and spreadsheet software. Good judgment skills. Effective customer service, organizational, and presentation skills. Demonstrated proficiency in spelling, punctuation, and grammar. Analytical or critical thinking skills. Basic business math proficiency. Knowledge of mathematical or statistical concepts. Ability to persuade, negotiate, or influence. Required Licenses and Certificates: Active LPN or LVN licensure in state hired, OR active compact multistate LPN license as defined by the Nurse Licensure Compact (NLC), OR active RN licensure in state hired OR active compact multistate RN license as defined by the Nurse Licensure Compact (NLC) others. Ability to handle confidential or sensitive information with discretion. We Prefer That You Have the Following: Preferred Work Experience: 3 years of provider relations and Medicare experience. Preferred Skills and Abilities: Knowledge of claims processing software. In-depth knowledge of Medicare program, guidelines, regulations governing coverage. Preferred Software and Other Tools: Working knowledge of Microsoft Access or other database software. Our Comprehensive Benefits Package Includes the Following: We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment. Subsidized health plans, dental and vision coverage 401k retirement savings plan with company match Life Insurance Paid Time Off (PTO) On-site cafeterias and fitness centers in major locations Education Assistance Service Recognition National discounts to movies, theaters, zoos, theme parks and more 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. 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.
$76k-108k yearly est. Auto-Apply 10d ago
Manager, Broker Relations (Remote)
Carefirst 4.8
Remote or Baltimore, MD job
**Resp & Qualifications** **PURPOSE:** The Broker Relations Manager's primary responsibility is to bring the value of CareFirst to the marketplace by engaging and working with CareFirst's distribution channel (brokers). This role combines strategic leadership with hands-on management to ensure brokers receive timely, accurate, and comprehensive assistance. The ideal candidate will foster a customer-centric culture while driving operational excellence and team development. **ESSENTIAL FUNCTIONS:** **Broker Relationship Management** + Serve as the primary escalation point for complex broker inquiries and issues, ensuring timely and satisfactory resolution. + Build and maintain strong relationships with key broker partners, full service producers and consultants, understanding their needs and business objectives. + Monitor broker satisfaction metrics and implement strategies to improve service delivery and partner experience. + Collaborate with sales and account management teams to support broker growth and retention initiatives. **Team Leadership & Development** + Lead, mentor, and develop a team of broker support representatives, fostering a collaborative and high-performance culture. + Conduct regular performance reviews, provide coaching, and identify training opportunities to enhance team capabilities. + Manage team scheduling, workload distribution, and resource allocation to ensure optimal coverage and efficiency. + Recruit, onboard, and train new team members in company policies, systems, and broker service best practices. Operational Excellence + Develop and implement broker service standards, workflows, and standard operating procedures to ensure consistent, high-quality support. + Monitor key performance indicators including response time, resolution time, ticket volume, quality and customer satisfaction scores. + Identify process improvement opportunities and implement solutions to enhance efficiency and service quality. + Manage and optimize the use of Broker360 and ticketing systems to track interactions, issues, and resolutions. + Ensure compliance with regulatory requirements, company policies, and industry standards. + Drive development and adoption of service dashboard(s) to track performance and progress, including broker-level dashboards. + Drive development and ongoing enhancement of broker portals to drive continued automation of broker work with CareFirst. + Support enhancements to Salesforce CRM to drive better data collection and reporting opportunities. **Communication & Collaboration** + Partner with Product, Underwriting, Operations, and IT departments to resolve systemic issues and improve broker experience. + Prepare and present regular reports on team performance, broker feedback, and service trends to senior leadership. + Communicate policy updates, system changes, and important information to the team and broker community. + Facilitate regular staff meetings to share updates, celebrate successes, and address challenges. + Attend and participate in business and community activities to promote CareFirst and identify new opportunities as needed. **SUPERVISORY RESPONSIBILITY:** This position manages people. **QUALIFICATIONS:** **Education Level** : Bachelor's Degree in marketing, business or related field OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience. **Experience:** + 5 years in sales, relationship management and/or marketing. + 1 year supervisory experience or demonstrated progressive leadership experience. **Licenses/Certifications:** + A current Health/Life License in Maryland, Virginia, and District of Columbia is required **Preferred Qualifications:** + Previous experience working directly with insurance brokers or agencies. + Lean Six Sigma or process improvement certification. + Experience implementing or managing CRM or customer service technology platforms. **Knowledge, Skills and Abilities (KSAs)** + Leadership & Team Development: Ability to inspire, motivate, and develop team members while maintaining accountability. + Problem-Solving: Strong analytical skills with ability to identify root causes and implement effective solutions. + Communication: Excellent written and verbal communication skills with ability to explain complex concepts clearly. + Relationship Building: Skilled at building trust and rapport with internal stakeholders and external partners. + Organization & Time Management: Ability to prioritize competing demands and manage multiple projects simultaneously. + Adaptability: Comfortable with ambiguity and able to adjust strategies in response to changing business needs. + Customer Focus: Unwavering commitment to understanding and exceeding broker and customer expectations. + Data-Driven Decision Making: Ability to interpret metrics and analytics to drive continuous improvement. Salary Range: $108,400 - $201,218 **Salary Range Disclaimer** The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements). **Department** Client Relationship Managers **Equal Employment Opportunity** CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information. **Where To Apply** Please visit our website to apply: ************************* **Federal Disc/Physical Demand** Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs. **PHYSICAL DEMANDS:** The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted. **Sponsorship in US** Must be eligible to work in the U.S. without Sponsorship. \#LI-KL1 REQNUMBER: 21520
$69k-90k yearly est. 34d ago
Commercial Lines Distribution Rep - Western PA/Western NY Territory (Remote)
NJM Insurance Group 4.7
Remote or Pittsburgh, PA job
. Commercial Lines Distribution Representatives meet regularly with agency/brokerage distribution partners in pursuit of organic growth opportunities in the small, mid and large size markets. Possess key commercial agency/brokerage relationships, presence and credibility in assigned territory along with a full working knowledge of our products offerings. These relationships will specifically be utilized to support and grow our distribution partner network in the region consistent with NJM's exclusive distribution model. The development of the relationships will be buttressed through regular interactions with the assigned partners through various modes of hospitality. This is a full time position primarily based in the western Pennsylvania/western New York territory, but may on occasion be asked to come to the corporate office in West Trenton, New Jersey. In addition to the annual base salary likely to fall around the $95,000-$100,000 range, this position has a quarterly and an annual incentive opportunity (5 total incentive opportunities a year, based upon performance). Essential Duties and Responsibilities: Essential functions of this job are listed below in order of priority. Reasonable accommodations may be made to enable individuals to perform the essential duties. Regular and predictable onsite attendance is an essential function of the job. Performance Expectations Distribution Representative Personal Leadership: • Understanding and execution of the NJM Annual and Long-Term Strategic Plan. • Actively performs and organizes all components of the sales life cycle from the dissemination of the NJM appetite, developing Partner understanding of that appetite, cultivating new business pipelines from inception through the binding of new business. • Plan annually with all assigned Partners and reach consensus on aggressive but attainable premium commitments per open location. • Works in tandem with all assigned Partners through effective communication of NJM initiatives, product updates and appetite evolution. • Remains current with industry trends, legislation and coverage changes. Productivity Quota • Awareness of Quarterly Quota Metrics and regular monitoring of premium goals throughout each quarter. • Scheduling and executing monthly production meetings with each assigned partner. Most are expected to be in person. • Scheduling and executing quarterly performance to plan meetings with the leadership of each assigned Partner to review current metrics in relation to the annual planned metrics. • Sends follow up reports for each meeting within three business days of the meeting. • Records each production meeting and performance to plan meeting in PDMS. Productivity Relationships • Schedules and coordinates resources for kick-off meetings to ensure a smooth onboarding and transition of new risks. • Works with assigned underwriters and schedules in-person UW introductory meetings with all assigned Partners. • Schedules a combination of lunches, breakfasts and dinner meetings with all assigned partners throughout the year. • Schedules relationship building activities with a variety of partners throughout the year. These can include a variety of events including professional sports games, music venues, comedy clubs, outdoor activities etc. • Regularly works with CAR team and has them included when practical at Production meetings and has them attend aforementioned activities. Strategic Awareness • Remains current with trends concerning NJM's lines of business. • Displays a strong understanding of NJM's Value Proposition. • Retains a strong working knowledge of NJM's Retro and LD Offerings. • Demonstrates the ability to dissect competitive plans from other carriers. • Collaborates with all departments across Commercial Lines to optimize Sales Performance. Essential Functions: • Match existing agent relationships and books of business opportunities with those of NJM • Based on this analysis recommend for appointment new commercial lines distribution partners in the territory. Ultimately through the review process sign up all appropriate agents based on the strength of these current relationships • Pursue, upsell, cross-sell, recapture opportunities with agencies/brokers • Coordinate New Business Proposal Meetings on key accounts to agencies and brokers; present NJM optional plans • Key account pre-renewal discussion with agencies • Review competitor plans with NJM underwriting to ensure best pricing offered • Lead annual planning process. Implement and monitor throughout year • Review underwriting appetite and services with agencies and brokers • Attend POS (Point of Sale) when possible, with agencies/brokers • Assist with contracting new agencies/brokers • Assist with onboarding and terminating agencies/brokers as required • Maintain agency/broker profiles • Attend corporate functions including Corporate Giving, Chamber of Commerce and Marketing events Required Qualifications Skills, Knowledge and Abilities: • Sales or Field/Production Underwriting oriented with experience and successful track record with standard commercial lines products in the noted territories • Ability to communicate orally and in writing with others to explain complex issues • Full knowledge of all commercial line's standard insurance products and usages • Ability to manage multiple clients, tasks, and requests • Adequate knowledge of rating procedures, coverages, and industry operations to effectively manage, maintain, and write assigned client and prospect lists • Knowledge of insurance markets and reference to markets • Knowledge of insurance underwriting procedures • Results oriented with the ability to meet strategic goals as required for the assigned territory • Excellent analytical, problem resolution, negotiating and project management skills • Professional, committed, and self-motivated with the ability to focus on daily tasks • Proficient with Microsoft Office - Outlook, Word, Excel, and Teams Legal Disclaimer: NJM is proud to be an equal opportunity employer. We are committed to attracting, retaining and promoting a diverse and inclusive workforce that is fully representative of the diversity that exists in the communities in which we do business. NJM reserves the right at any time to amend, add or delete any aspect of the job description for this position based on business needs. Compensation: Salary is commensurate with experience and credentials. Pay Range: $88,176-$111,218 Eligible full-time employees receive a competitive Total Rewards package, including but not limited to a 401(k) with employer match up to 8% and additional service-based contributions, Health, Dental, and Vision insurance, Life and Disability coverage, generous PTO, Paid Sick Leave, and paid parental leave in addition to state-mandated leave. Employees may also be eligible for discretionary bonuses. Legal Disclaimer: NJM is proud to be an equal opportunity employer. We are committed to attracting, retaining and promoting a diverse and inclusive workforce that is fully representative of the diversity that exists in the communities in which we do business.
$95k-100k yearly Auto-Apply 15d 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. 33d ago
Senior Accounts Payable Specialist
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 Accounts Payable Specialist Responsibilities: · Completion of several complex daily, weekly, and monthly reconciliation processes across migrated and non-migrated platforms for IBC and AHA/IA · Daily research, preparation, and decision-making of the Positive Pay Exception Bank File · Completion of various Escheat-related functions such as: Daily and monthly reconciliations, research variances, inquiry handling, escheat vendor system updates, and logging of deleted escheat checks · Review AHA escheat upload files for accuracy, etc. · Review, update, and tracking of outstanding payments for Garnished providers with the Legal department · Monitoring and handling of IRS-related Levys · Daily review and handling of incident tickets initiated by or submitted to Disbursements through the Service Now system · Assembling of Funding requests for AmeriHealth Casualty's clients · Verifying AmeriHealth Casualty's clients' funding totals · Daily PeopleSoft pay cycle - Processing and delivery of internal/external checks, bank file uploads, stop pay (system and bank), check copy requests, and handling associated research inquiries · Positive Pay handling (validate exception payments through bank portals) · Active participant in the testing of PeopleSoft system Upgrades and bank payment testing · Reconciliation and bank release of Provider EFT payments (releasing files and calling payment file totals to the bank) · Various 1099 tasks such as: testing of 1099 files, 1099 balancing, addressing TIN mismatches on the IRS website, handling 1099 returned mail, etc. · Identifying outstanding checks for the Checks not Cashed and Due Diligence process and submitting data to the vendor · Working with Claims/Refund teams on research and processing of AHA Due Diligence batches · Uploading MPY requests as needed · Maintaining and updating desk-level procedures and other departmental reports/files · Research and handling of Notification of Change (NOCs) / EFT failures and collaborating with the provider teams on reissuance · Participates in complex projects assigned by management and all other duties assigned by management · Completes work with a limited degree of supervision Qualifications · College Degree preferred · At least 2-3 years of related experience required · Intermediate knowledge of Microsoft Excel, Word, and Outlook (Excel skills required) · Working knowledge of various migrated and non-migrated applications (Health Proof, Health Rules, CareFirst Bridge, PNC ECHO, COR, CMS, etc.) · PC experienced required · Good verbal and written communication skills are necessary · Ability to be flexible, adapt, multi-task, and prioritize · Detail and results-oriented · Highly organized · Ability to work in a team setting and individually 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 that is compatible with the free Microsoft Authenticator app.
$66k-82k yearly est. 60d+ ago
SEO and Brand Visibility Intern
Grange Insurance Careers 4.4
Columbus, OH job
Work Schedule: 38.75hrs/week; Hybrid - 2 days in office (Tuesday & Wednesday) and 3 days remote Duration: 10 weeks A Great Place to Intern Grange provides a unique internship experience through the Grange Intern Development Program. The 10-week program is designed to expose students to the insurance industry through networking, mentoring, hands-on work experience, and community service. The interns will work day-to-day in their respective departments while also working as a group on a corporate project, which concludes with a capstone presentation to senior leaders. If you're up for the challenge, we encourage you to apply today! The 10-week internship program will be from mid-June to mid-August. Summary: This position, which bridges public relations (PR) and search engine optimization (SEO), is responsible for managing an ongoing project overseeing two brands' online presences. It will ensure accurate information about each brand, the companies, their products, their core values, and real customer experiences are found across the internet to maintain accuracy and consistency wherever our brands are found online. What You'll Be Doing: Search for inaccuracies online and develop a proactive plan to address it while keeping our digital ecosystem maps updated. Work with Grange employee subject matter experts to gather correct information for online updates. Communicate with website owners and/or online authors to request corrections to inaccurate company information and track when corrections are completed. Potential opportunity to assist with website, social media, and/or public relations copywriting; AI search prompt monitoring and analysis; digital marketing data and analytics tracking and analysis; and/or front-end website development, if your skills and interests align. What You'll Bring To The Company: Ideally, pursuing an associate or bachelor's degree. One or more years of previous work or internship experience. Strong communication and organization skills. Affinity for communications, marketing, public relations, search engine optimization (SEO), brand management, online reputation management, journalism, and/or marketing data and analytics. Must be willing to participate in a highly collaborative and team-oriented environment. Ability to oversee and execute a project through to completion as well as track and measure results. About Us: Grange Insurance Company, with $3.4 billion in assets and more than $1.59 billion in annual revenue, is an insurance provider based in Columbus, Ohio. Through its network of independent agents, Grange offers auto, home and business insurance protection. Established in 1935, the Grange Insurance Company and its affiliate Integrity Insurance Company serve policyholders in Georgia, Illinois, Indiana, Iowa, Kentucky, Michigan, Minnesota, Ohio, Pennsylvania, South Carolina, Tennessee, Virginia, and Wisconsin. Learn more about Grange Insurance. Now Is An Exciting Time To Be A Grange Intern: The key to our success is dedicated associates and a winning workplace culture. We offer an inclusive environment, promote work-life balance, and offer great hands-on experience. We know the power of our company ultimately comes from our associates. Investing in them is an investment in our success. Our associates take their work seriously, but not themselves. They have fun, are energetic and bring passion to their work. We don't just accept difference - we celebrate it, we support it and we thrive on it for the benefit of our associates, our products and our community. Grange Insurance is proud to be an equal opportunity workplace. We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity or Veteran status.
$35k-46k yearly est. 22d ago
Business Transformation & Process Improvement Intern
Grange Insurance 4.4
Columbus, OH job
Work Schedule: 38.75hrs/week, Hybrid - 2 days in office (Tuesday & Wednesday) and 3 days remote Duration: 10 weeks A Great Place to Intern Grange provides a unique internship experience through the Grange Intern Development Program. The 10-week program is designed to expose students to the insurance industry through networking, mentoring, hands-on work experience, and community service. The interns will work day-to-day in their respective departments while also working as a group on a corporate project, which concludes with a capstone presentation to senior leaders. If you're up for the challenge, we encourage you to apply today! The 10-week internship program will be from mid-June to mid-August. Summary: The Business Transformation & Process Improvement Intern will support enterprise-wide initiatives focused on innovation, customer experience, and operational excellence. This role offers hands-on exposure to how organizations evolve strategy into execution by improving processes, modernizing capabilities, and enhancing customer outcomes. What You'll Be Doing: The intern will collaborate with cross-functional teams to analyze current-state processes, identify improvement opportunities, support innovation efforts, and contribute to initiatives that drive measurable business impact. * Learning and Applying lean and six-sigma methodologies to projects * Performing data analysis to uncover trends, inefficiencies, and improvement opportunities * Supporting customer journey mapping and management * Participating in and collaborating in conducting user needs assessments with business partners and across business functions What You'll Bring To The Company: This opportunity is ideal for individuals interested in business transformation, digital innovation, and customer-centric problem-solving. * Ability to be supportive and collaborative in an agile, fast paced environment * Comfort work independently and within a team * Strong problem solving and analytical skills. * Curious mindset with a desire to experiment with new technology and solutions * Major focused on Business, Analytics, Industrial Engineering, Economics, or related fields. About Us: Grange Insurance Company, with $3.4 billion in assets and more than $1.59 billion in annual revenue, is an insurance provider based in Columbus, Ohio. Through its network of independent agents, Grange offers auto, home and business insurance protection. Established in 1935, the Grange Insurance Company and its affiliate Integrity Insurance Company serve policyholders in Georgia, Illinois, Indiana, Iowa, Kentucky, Michigan, Minnesota, Ohio, Pennsylvania, South Carolina, Tennessee, Virginia, and Wisconsin. Learn more about Grange Insurance. Now Is An Exciting Time To Be A Grange Intern: The key to our success is dedicated associates and a winning workplace culture. We offer an inclusive environment, promote work-life balance, and offer great hands-on experience. We know the power of our company ultimately comes from our associates. Investing in them is an investment in our success. Our associates take their work seriously, but not themselves. They have fun, are energetic and bring passion to their work. We don't just accept difference - we celebrate it, we support it and we thrive on it for the benefit of our associates, our products and our community. Grange Insurance is proud to be an equal opportunity workplace. We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity or Veteran status.
$29k-34k yearly est. 21d ago
Software Engineer Intern
Grange Insurance Careers 4.4
Columbus, OH job
Work Schedule: 38.75hrs/week, Hybrid - 2 days in office (Tuesday & Wednesday) and 3 days remote Duration: 10 weeks A Great Place to Intern Grange provides a unique internship experience through the Grange Intern Development Program. The 10-week program is designed to expose students to the insurance industry through networking, mentoring, hands-on work experience, and community service. The interns will work day-to-day in their respective departments while also working as a group on a corporate project, which concludes with a capstone presentation to senior leaders. If you're up for the challenge, we encourage you to apply today! The 10-week internship program will be from mid-June to mid-August. What You'll Be Doing: As a Software Engineering Intern, you'll be working on our application development teams focused on insurance applications - working to make insurance easy for our customers and agents. You will enrich and expand your skillset by working on a wide variety of applications and technology stacks including React, Javascript, C# .NET, Mobile, SQL, data modeling and automated test engineering development. The chance to gain experience on agile methodology and work through the full process from reading and interpreting requirements, development, testing and finally implementation. You will have the opportunity to develop their MuleSoft skill set while working with our team. This will not only enhance your technical abilities but also provide you with valuable hands-on experience. What You'll Bring To The Company Majoring in Computer Science or other applicable STEM fields Willingness to learn and manage multiple tasks at once Ability to analyze and possess strong problem-solving skills Strong collaboration skills and ability to work within an agile team About Us: Grange Insurance Company, with $3.4 billion in assets and more than $1.59 billion in annual revenue, is an insurance provider based in Columbus, Ohio. Through its network of independent agents, Grange offers auto, home and business insurance protection. Established in 1935, the Grange Insurance Company and its affiliate Integrity Insurance Company serve policyholders in Georgia, Illinois, Indiana, Iowa, Kentucky, Michigan, Minnesota, Ohio, Pennsylvania, South Carolina, Tennessee, Virginia, and Wisconsin. Learn more about Grange Insurance. Now Is An Exciting Time To Be A Grange Intern: The key to our success is dedicated associates and a winning workplace culture. We offer an inclusive environment, promote work-life balance, and offer great hands-on experience. We know the power of our company ultimately comes from our associates. Investing in them is an investment in our success. Our associates take their work seriously, but not themselves. They have fun, are energetic and bring passion to their work. We don't just accept difference - we celebrate it, we support it and we thrive on it for the benefit of our associates, our products and our community. Grange Insurance is proud to be an equal opportunity workplace. We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity or Veteran status.
$36k-46k yearly est. 21d ago
Transformation and Analytics Intern - Customer Interactions
Grange Insurance 4.4
Columbus, OH job
Work Schedule: 38.75hrs/week, Hybrid - 2 days in office (Tuesday & Wednesday) and 3 days remote. Duration: 10 weeks A Great Place to Intern Grange provides a unique internship experience through the Grange Intern Development Program. The 10-week program is designed to expose students to the insurance industry through networking, mentoring, hands-on work experience, and community service. The interns will work day-to-day in their respective departments while also working as a group on a corporate project, which concludes with a capstone presentation to senior leaders. If you're up for the challenge, we encourage you to apply today! The 10-week internship program will be from mid-June to mid-August. Summary: We're seeking an enthusiastic Digital Transformation & Analytics Intern to join our Customer Interactions Vendor Relations, Quality, and Training Team. In this entry-level role, you will assist in designing, implementing, and optimizing technology solutions that transform our quality assurance, training programs, and vendor relationship management processes. You will gain hands-on experience with data analytics initiatives and emerging AI technologies while supporting our Claims, Contact Center, and Billing functions. What You'll Be Doing: * Assist in evaluating and improving technology and reporting solutions that support quality monitoring, training, and vendor management across our Claims, Contact Center, and Billing functions. * Support data analytics initiatives including dashboard creation, reporting, and identifying insights from operational data. Conduct analytics, such as trend analysis, to translate data into clear, actionable insights for leadership. * Help assess current processes and research process improvements, automation, and potential AI solutions to improve efficiency and quality. * Collaborate with team members to gather requirements and contribute to technology implementation projects. * Learn about insurance operations while supporting documentation and process improvement initiatives. What You'll Bring to The Company: * Currently pursuing or recently completed a Bachelor's degree in Data Science, Analytics, Computer Science, Information Technology, or related field * Experience with data analysis and visualization tools (e.g., Excel, Power BI, Tableau) or programming languages (Python, R, SQL) * Demonstrated strong analytical thinking and problem-solving skills with attention to detail. * Interest in AI/ML applications and how data drives business decision-making * Excellent communication skills with ability to explain technical concepts clearly. About Us: Grange Insurance Company, with $3.4 billion in assets and more than $1.59 billion in annual revenue, is an insurance provider based in Columbus, Ohio. Through its network of independent agents, Grange offers auto, home and business insurance protection. Established in 1935, the Grange Insurance Company and its affiliate Integrity Insurance Company serve policyholders in Georgia, Illinois, Indiana, Iowa, Kentucky, Michigan, Minnesota, Ohio, Pennsylvania, South Carolina, Tennessee, Virginia, and Wisconsin. Learn more about Grange Insurance. Now Is An Exciting Time To Be A Grange Intern: The key to our success is dedicated associates and a winning workplace culture. We offer an inclusive environment, promote work-life balance, and offer great hands-on experience. We know the power of our company ultimately comes from our associates. Investing in them is an investment in our success. Our associates take their work seriously, but not themselves. They have fun, are energetic and bring passion to their work. We don't just accept difference - we celebrate it, we support it and we thrive on it for the benefit of our associates, our products and our community. Grange Insurance is proud to be an equal opportunity workplace. We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity or Veteran status.
$36k-44k yearly est. 21d ago
Pharmacy Claims Auditor (Remote - PA, NJ, and DE)
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 Auditor, Payment Integrity role conducts pharmacy claim audits for Independence Blue Cross to ensure accurate provider payments, detect fraud, waste, or abuse, and improve audit processes. It requires a Certified Pharmacy Technician with at least four years of experience, including pharmacy and audit work, strong analytical skills, and proficiency in Microsoft Office and pharmacy claims systems. Conduct audits of claims submitted to Independence Blue Cross (IBX) to ensure accuracy of provider payments and charges. Analyze provider billing patterns to detect potential fraud, waste, or abuse. Perform audits through daily reviews, live audits, and desk audits to identify inappropriate billing practices. Review and verify provider billing records, collaborating with CFID audit analysts, auditors, investigators, internal, and external sectors Execute standard provider audit assignments using sound audit methodologies to uncover patterns of abuse or fraud. Screen and audit claim samples-both summary and detailed-to select cases for further review. Initiate and validate claim adjustments, maintain comprehensive audit documentation, and prepare statistical reports. Identify and escalate potential provider fraud or abuse to management. Contribute to the development and implementation of new audit processes and functions. Qualifications • Certified Pharmacy Technician (CPhT) required. • Minimum of four (4) years of relevant experience, including: • At least two (2) years in retail or hospital pharmacy. • At least two (2) years in pharmacy audit. • Extensive understanding of healthcare provider audit practices and medical terminology. • Familiarity with fraud, waste, and abuse detection methodologies. • Strong written and verbal communication skills for reporting and presenting audit findings • Proficiency in Microsoft Office applications, including Excel, Word, Outlook, SharePoint, and Access. • Advanced Excel skills (pivot tables, VLOOKUP, data analysis). • Experience with pharmacy claims systems such as RxTrack and RxClaim is preferred but not required. Fully Remote: This role is designated by Independence as fully remote. The incumbent will not be required to report to one of Independence's physical office locations to perform the work. However, 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 that is compatible with the free Microsoft Authenticator app.
$47k-59k yearly est. 13d 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
Claim Experience Professional - Hybrid
Arbella Insurance 4.6
Remote or Quincy, MA job
Exceptional opportunity to join our dynamic Claim Service Center Team! Why Arbella? At Arbella, we're focused on people. We work hard to attract and retain the best. That means providing a great work environment, encouraging work/life balance, offering flexible work arrangements, and competitive salaries and benefits packages. We invest in our employees and encourage them to grow so that we, too, can grow as a company. Other perks include: • On-site gym and fitness classes and one-on-one personal training • On-site nurse, nutritional counseling, and mental health resources • Full-service cafeterias • Free shuttle service to Quincy Adams T Station • Tuition assistance programs • Opportunities to get involved: Arbella Activities Committee, Diversity and Inclusion Council, and more • A company committed to community: volunteer opportunities, employee- led community efforts, and the Arbella Insurance Foundation • Robust training, mentorship, and professional/personal development programs • Colleagues who genuinely care about each other Arbella is committed to building a workplace that's diverse, inclusive, and equitable for everyone. We've created a culture that supports a diverse workplace where all are valued for their talents and are empowered to reach their full potential. It's no wonder our employees have voted Arbella one of the Boston Business Journal's “Best Places to Work” every year since 2009! The Arbella Claim Experience Professional is an individual who understands and supports our commitment to delivering exceptional service consistent with Arbella's brand. They thrive in a fast-paced environment, have an inquisitive mindset, and adapt well to change. They are eager to learn and develop new skills, build meaningful relationships, and collaborate effectively on a team to achieve department goals. Key Responsibilities Effectively communicates with customers, agents, third parties and vendors across multiple communication channels. Establishes electronic claims in all lines of business and states, using care and compassion to guide customers through the claim process. Researches and analyzes claim activity, proactively identifies solutions to resolve customer inquiries and uses sound judgement when escalating urgent customer issues. Performs a myriad of claim tasks including ordering appraisals, creating rental reservations, and establishing lines of communication between customers and their adjuster. Builds relationships with our internal and external customers, agents, vendors, and others, and is committed to delivering exceptional service. Contributes to a positive team atmosphere, overall department goals, and is active in promoting Arbella's core values including Diversity and Inclusion efforts. May have the opportunity to work in other Arbella contact centers to expand skills/knowledge based on business need. Performs other related work as required or requested. Requirements: Some work experience in a customer service environment preferred. Sound interpersonal, organizational, communication and collaboration skills Data entry proficiency Ability to multi-task and work in a fast-paced environment. We value work-life balance, so our work schedule is 36.25 hours per week. All Arbella employees are eligible for a profit share bonus program, exceptional benefit and wellness programs, career development, flexible schedules and much more! Check out some of the amazing benefits and programs we offer to all employees. Full time schedules are available with a hybrid work arrangement. Arbella offers work from home flexibility up to 2 days per week once the employee is fully trained and performing successfully. Our current reasonable and good faith estimate of the annual salary or hourly wage range for this position is approximately $45,000 ($24.00 an hour) - $47,000 ($25.00 an hour) based on a variety of factors including, but not limited to, relevant skills and experience,. Please note: The advertised pay range is not a guarantee or promise of a specific wage. Apply today! #LI-CL1
$45k-47k yearly Auto-Apply 34d ago
Clinical Support Representatives
Bluecross Blueshield of Vermont 4.6
Remote or Montpelier, VT job
Blue Cross is hiring Clinical Support Representatives to work alongside our clinical review team as part our Utilization Management department. Job responsibilities include verifying member benefits, provider networks, and prior approval requirements for authorization of services all in a call center type environment. Work hours are Monday-Friday 8:00-4:30. Experience working in the medical field as an office assistant, medical coder, or Licensed Nursing Assistant is preferred and familiarity with medical terminology is helpful. Location: If hired, there will be a six week in-person training program at our Berlin, Vermont office. Representatives will continue working on-site five days per week until proficiency has been demonstrated in performing the role independently. After this time, employees within a 50-mile radius will be expected to come to the office on Wednesdays with flexibility to work remotely the rest of the week. Starting pay at $20.00 per hour. Six-week paid training. Target start date is Wednesday, February 18. Robust benefits package including: Health insurance (including vision) Dental coverage (free to employees) Wellness Program with a $500 year-end incentive 401(k) with employer match Life Insurance Disability Insurance Combined time off (CTO) - 20 days per year + 10 paid holidays Tuition reimbursement Student Loan Repayment Dependent Caregiver Benefits And more! Diversity, Equity, and Inclusion: Blue Cross VT is committed to creating an inclusive environment where employees respect, appreciate, and value individual differences, both among ourselves and in our communities. We welcome applicants from all backgrounds and experiences to join us in our commitment to the health of Vermonters, outstanding member experiences, and responsible cost management for all the people whose lives we touch. Learn more about our DE&I commitment at **************************************************************** **Complete job description attached to ADP posting
$20 hourly 11d ago
Claim Technical Assistant - Hybrid
Arbella Insurance 4.6
Remote or Quincy, MA job
Why Arbella? At Arbella, we're focused on people. We work hard to attract and retain the best. That means providing a great work environment, encouraging work/life balance, offering flexible work arrangements, competitive salaries and exceptional benefits packages. We invest in our employees and encourage them to grow so that we, too, can grow as a company. Other perks include: • On-site gym and fitness classes and one-on-one personal training • On-site nurse, nutritional counseling, and mental health resources • Full-service cafeterias • Free shuttle service to Quincy Adams T Station • Tuition assistance programs • Opportunities to get involved: Arbella Activities Committee, Diversity and Inclusion Council, and more • A company committed to community: volunteer opportunities, employee- led community efforts, and the Arbella Insurance Foundation • Robust training, mentorship, and professional/personal development programs • Colleagues who genuinely care about each other Arbella is committed to building a workplace that's diverse, inclusive, and equitable for everyone. We've created a culture that supports a diverse workplace where all are valued for their talents and are empowered to reach their full potential. It's no wonder our employees have voted Arbella one of the Boston Business Journal's “Best Places to Work” every year since 2009! Start an exceptional career in Claim! As a Claim Technical Assistant you will provide both administrative and technical support to all Claim functions and build a great foundation for future career growth in Claim! Process loss and expense payments Skilled data entry into multiple claim and related databases systems. Request police reports and other investigative material Request appropriate letters and correspondence as directed by the Claim Professional. Provide administrative support to Claim Professionals (i.e. printing, filing and copying documents, etc.). Answer routine questions relative to area of responsibility which may include contact with agents, insured(s) or others. Keeps supervisor informed verbally and in writing of activities and problems within assigned area of responsibility; refers matters beyond limits of authority and expertise to supervisor for direction. Requirements Able to work in a fast paced environment. Strong interest in advancement within the Claim Department Sound MS Office skills and able to work in an organized manner Good time management skills with strong attention to detail Some office or customer service work experience preferred. Our work schedule is 36.25 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. Our current reasonable and good faith estimate of the annual salary or hourly wage range for this position is approximately $41,470 ($22.00 an hour) - $44,014 ($23.35 an hour) based on a variety of factors including, but not limited to, relevant skills and experience,. Please note: The advertised pay range is not a guarantee or promise of a specific wage. Apply today!!
$41.5k-44k yearly Auto-Apply 60d+ ago
Assistant General Counsel - Litigation (Hybrid)
Carefirst, Inc. 4.8
Remote or Baltimore, MD job
Resp & Qualifications Purpose The Associate General Counsel provides a complete range of legal services in support of the Assistant General Counsel, Litigation General Counsel, and the Division(s), Department(s), and/or specialized areas of legal practice to which the position is assigned with a focus on regulatory, compliance, litigation, and employment law. Essential Functions Provides advice and counsel to management and/or their designees in complex and rapidly evolving areas of the law; evaluates divisional and departmental initiatives and represents the corporation's legal interests on intercompany management committees; researches, analyzes and writes legal memoranda and provides legal guidance on a wide variety of legal, regulatory, contractual, compliance, corporate governance and operational matters, including the interpretation and implementation of legislation; assists with and/or supports representation of the corporation's legal interests by interfacing with opposing counsel and regulatory agencies on issues having significant impact on company operations and/or finances. Responsible for representing the company before regulators including, but not limited to the EEOC, MCCR, DCOHR or other state or local equivalent, the NLRB, MIA and OAH. Support Litigation General Counsel and employment counsel, as necessary. Reviews subpoenas, garnishments, and other court issued documents for legal sufficiency and provides direction to legal support staff to ensure that the corporation's responses are in an appropriate manner. Oversees the filing of proofs of claim in bankruptcy matters to ensure that the corporation's financial interests are adequately protected, as well as supports Assistant General Counsel by analyzing business operations and recommending and implementing processes to maximize effectiveness of legal resources. Provides guidance to Paralegals and Legal Assistants with respect to legal research projects and drafting of memoranda. Qualifications Education Level: Juris Doctor Licenses/Certifications Required: Bar Admission to the MD or DC Bar within 1 Year Experience: 1 year experience in the legal field. Healthcare, regulatory, or another relevant base of experience is required. Preferred Qualifications: 1+ year of regulatory experience; minimum of 1 year in ERISA/health/managed care issues and experience in bankruptcy, employment law, litigation and/or arbitration preferred. Knowledge, Skills and Abilities (KSAs): Strong analytical, interpersonal, and written and verbal communications skills. Ability to follow instructions, to be flexible/versatile, and to work independently. Salary Range $123,440 - $220,649 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 401(k) 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 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-LJ1 #J-18808-Ljbffr
$123.4k-220.6k yearly 3d ago
Research Specialist
Bluecross Blueshield of Vermont 4.6
Remote or Berlin, VT job
Blue Cross and Blue Shield of Vermont is looking for a Research Specialist to join our Inter-Plan Programs team. Our company culture is built on an unwavering focus on the health of Vermonters, outstanding member experiences, and responsible cost management for all the people whose lives we touch. We offer a balanced and flexible workplace, an onsite gym, fitness and wellness programs, a competitive salary and full benefits package including medical and dental insurance, vision, 401K, paid time off and holidays, tuition reimbursement and student loan repayment, dependent caregiver benefits, and resources to support your ongoing personal and professional growth and development. COMPENSATION: The hourly range for this position is $18.00-21.00. Additional compensation opportunities and incentives will be detailed during the interview process. Please note that the range listed above is our good faith estimate of the hiring range for this role. If you are hired at Blue Cross and Blue Shield of Vermont, your final base salary compensation will be determined based on factors such as skills, competencies, education, experience, and internal equity across the current team. We also offer a robust benefits package with significant value (see below). LOCATION : Blue Cross has transitioned to a hybrid workplace where employees within driving distance of our Berlin, VT office work Wednesdays in the office with flexibility to work remotely the rest of the week. Research Specialist Responsibilities: Responsible for a high level of quality by providing information and or initiating appropriate corrective actions to resolve a customer's inquiry based on a thorough and comprehensive understanding of BCBSVT contracts, policies, systems and procedures. Maintain relationships between the Plan and its customers. Work with all levels of expertise including provider billing clerks to provider business managers, other BCBS plans as well as our subscribers and members. Work closely with other business units to address customer concerns and communicate feedback to our customers Accurate and timely interpretations of the Plan policies and procedures while maintaining the absolute confidentiality of member and provider information. Research Specialist Qualifications: High school graduation or equivalent is required. Two year college degree is preferred A minimum of 1-3 years customer service or claims processing experience in a healthcare or health insurance setting is required. Experience in a provider's billing office is preferred. Research Specialist Benefits: Health insurance (including vision) Dental coverage (free to employees) Wellness Program 401(k) with employer match + automatic employer contribution Life Insurance Disability Insurance Combined time off (CTO) - 20 days per year + 10 paid holidays Tuition Reimbursement Student Loan Repayment Dependent Caregiver Benefits Diversity, Equity, and Inclusion: Blue Cross VT is committed to creating an inclusive environment where employees respect, appreciate, and value individual differences, both among ourselves and in our communities. We welcome applicants from all backgrounds and experiences to join us in our commitment to the health of Vermonters, outstanding member experiences, and responsible cost management for all the people whose lives we touch. Learn more about our DE&I commitment at **************************************************************** *full job description attached to ADP posting
$18-21 hourly Auto-Apply 15d 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

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Updated January 18, 2026

Zippia gives an in-depth look into the details of CDPHP, including salaries, political affiliations, employee data, and more, in order to inform job seekers about CDPHP. The employee data is based on information from people who have self-reported their past or current employments at CDPHP. The data on this page is also based on data sources collected from public and open data sources on the Internet and other locations, as well as proprietary data we licensed from other companies. Sources of data may include, but are not limited to, the BLS, company filings, estimates based on those filings, H1B filings, and other public and private datasets. While we have made attempts to ensure that the information displayed are correct, Zippia is not responsible for any errors or omissions or for the results obtained from the use of this information. None of the information on this page has been provided or approved by CDPHP. The data presented on this page does not represent the view of CDPHP and its employees or that of Zippia.

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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