81 jobs found in Baltimore

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: Develops and Implements strategy for the Experience and Digital Marketing product line and is responsible for the product planning and execution throughout the Product Lifecycle, including gathering and prioritizing product and customer requirements, defining the product vision. Working with Product Owners, IT, and other stakeholders to prioritize product and customer requirements against the business strategy, product roadmap, and value drivers. Partners closely with engineering to ensure we deliver winning products that meet CareFirst and member needs. Oversees the product roadmap development process ensuring it includes the UX, design teams, operations managers, engineering managers, and finance teams. Confirms project deadlines with support from the product owners and delivery team. To ensure the product development stages meet internal and external stakeholders'. expectations. Also, provide timely and...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: Performs complex analysis, design, development, automated unit and integration testing, and debugging of computer software ranging from operating system architecture integration and software design to selection of computer systems, language, and/or equipment. Designs, codes, tests, develops, and documents application programs for computer systems. Works with end-users and project stakeholders to define system scope and objectives. Manages modifications to and maintenance of operational programs and procedures. Leads stakeholder and product owner meetings to define software requirements and creates highly complex systems. Acts as a mentor to junior engineers. ESSENTIAL FUNCTIONS: Lead a team of software engineers in the design, development, and implementation of multiple applications. Performs and leads the detail technical design, coding, code review and testing of new applications and enhancements of...

CareFirst BlueCross BlueShield 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: The main purpose of a data analyst is to find meaning in data as a thought leader so that the derived knowledge can be used to make informed decisions and assist the organization in making better business decisions. ESSENTIAL FUNCTIONS: Engages in data exploration using various programming languages (reading and writing code), requiring advanced knowledge of multiple database structures Collect, analyze, and interpret data to glean insights, and develop business appropriate recommendations Serve as an expert resource supporting data questions and issues from...

CareFirst BlueCross BlueShield 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: This role will lead, guide, strategize and manage negotiations for provider-specific institutional, ancillary, and professional contracts. Key responsibilities include negotiating contract terms in accordance with regulatory requirements, analyzing financial data to evaluate implications across various business lines, while ensuring compliance with company policies and procedures, and coordinating with the Payment Transformation team to transition fee-for-service arrangements to value-based care. This role will also oversee complex projects related to provider...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: The intern is an integral member of the Product team, part of the larger Enterprise Product and Specialty division at CareFirst BlueCross BlueShield. This team is responsible for the product lifecycle of CareFirsts Commercial Medical and Ancillary Products from strategic conception to launch to maintenance. Ideally this opportunity would run as a year-round internship program. The ideal candidate is someone who can work throughout the year up to 15-20 hours in the Fall/Spring AND full time (35 to 40) in the summer. This is a hybrid internship, and the student will be expected to come into the office once per week. ESSENTIAL FUNCTIONS: Seek to learn and understand insurance products in-depth. Analyze and gather competitive intelligence information for differing lines of business (medical, dental, pharmacy, life, disability, wellness, etc.). Analyze market and segment competitors. Conduct ad hoc...

CareFirst BlueCross BlueShield Resp & Qualifications This is a year-round internship. The ideal candidate is someone who can commit to work throughout the year full-time 40 hours in the Summer and part-time up to 15-20 hours in the Spring/Fall. (Remote MD/VA/DC only) PURPOSE: The Human Resources Operations Intern will sit within our HR Connect team that supports the entire organization. You will have the unique opportunity to learn how to respond to general associate inquiries about human resources programs, procedures, and policies. You will serve as the initial point of contact for HR inquiries for the workforce (Tier 1 support). Assist functional teams daily to ensure all customer requests are handled in a timely and confidential manner. ESSENTIAL FUNCTIONS: Learn to respond to general intake inquiries from employees and manages the process necessary to bring to resolution in a timely manner. Assist with maintaining information systems and...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: We are looking for an experienced Nurse Care Manager to work remotely from within the greater Baltimore, Maryland metropolitan area with both Adult and Pediatric members. The incumbent will be expected to come into a CareFirst location periodically for meetings, training and/or other business-related activities. Under minimal supervision, the Nurse Care Manager researches and analyzes the Adult and Pediatric member's medical and behavioral health needs and healthcare cost drivers. The Nurse Care Manager works closely with the member / members family and the interdisciplinary care team to ensure members have an effective plan of care and positive member experience that leads to optimal health and cost-effective outcomes. ESSENTIAL FUNCTIONS: Identifies members with acute/complex medical and/or behavioral health conditions. Engages onsite and/or telephonically with member, family and providers to...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: Acts as an internal expert to ensure that as value-based reimbursement and medical policy models are developed and implemented. Provides expert knowledge to support effective partnership with provider entities and guidance on the appropriate quality measure capture and proper use of CPT and ICD 10 codes in claims submissions. Utilizes coding expertise, combined with medical policy, credentialing, and contracting rules knowledge to build the effective guides and resources for providers on the expected methodologies for billing and code submissions to maximize quality and STARs outcomes while not compromising payment integrity. Provides expertise and mentoring to other team members. 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...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: The Clinical Medical Review Nurse handles day to day review of professional and institutional claims and provider appeals that require medical review to determine if the claim is eligible for benefits and to support claims processing and/or adjudication. The incumbent will handle pre claim medical review for Commercial and Federal lines of business. This position assists in determining acceptable medical risk to the organization by analyzing medical information of applicants for enrollment in specific policies. This role will also understand the merits of legal or accreditation actions. We are looking for an experienced RN to work remotely from within the greater Baltimore metropolitan area. The incumbent will be expected to come into a CareFirst location periodically for meetings, training and/or other business-related activities. ESSENTIAL FUNCTIONS: Receives, researches, reviews and analyzes...

CareFirst BlueCross BlueShield 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 Data Governance Equal Employment Opportunity CareFirst...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: We are looking for an RN with significant clinical educator experience to work in a hybrid role from within the greater Baltimore/ Washington metropolitan area. The incumbent will be expected to come into a CareFirst location periodically for meetings, trainings, provide training support for Care Management employees and/or other business-related activities. This role provides relevant new hire and supportive ongoing training/professional development which create and maintain a motivated, skilled and effective team through which organizational goals are achieved. In this position, the incumbent will be supporting all market segments of the Care Management Department providing training for Care Management employees related to new technology and documentation with our Guiding Care platform, the Care Management process, and interventions to drive outcomes for our members. Demonstrated experience with...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: We are looking for Medical Management Coordinator to work remotely from within the greater Baltimore/ Washington metropolitan area. The incumbent will be expected to come into a CareFirst location periodically for meetings, training and/or other business-related activities. In this position, you will have direct and measurable impact on the lives of CareFirst members that are part of the Maryland Medicaid line of business. The Medical Management Coordinator plays a critical role in ensuring members receive timely, appropriate, and coordinated care. This position supports the clinical teams and Care Managers by addressing non-clinical tasks related to care coordination enabling clinical staff to perform at the top of their license. This position includes frequent telephone and email communications with members, providers, and interdisciplinary care teams. Included in these communications are monitoring...

CareFirst BlueCross BlueShield Resp & Qualifications DC/MD/VA The Data Analytics Intern role exists as a hiring strategy to bring in students enrolled in an accredited college or university who are pursuing at least a Bachelors degree in analytical and/or data visualization related fields to learn the business and technical side of healthcare from the ground up. Data and Analytics creates cutting edge analytic tools/visualizations to drive insights and faster decision making within the organization and provides critical support for key corporate initiatives. This role will require interaction with project stakeholders and business partners within the organization. This position will use analytically derived insights to develop and test solutions that enhance consumer engagement, improve health outcomes and reduce health care costs. This is a fast-paced, collaborative, and iterative environment requiring quick learning, agility and flexibility. This is a Year-Round...

CareFirst BlueCross BlueShield Resp & Qualifications CANDIDATES MUST BE LOCAL TO MD, DC, NORTHERN VA AND ABLE TO COME IN TO BALTIMORE OFFICE APPROXIMATELY ONCE A MONTH. PURPOSE: Provides Operations Support by obtaining facts; analyzing problems; designing solutions; developing testing methods; conducting and documenting tests; providing operating information to customers. ESSENTIAL FUNCTIONS: Research and improve operations by examining and researching systems problems by obtaining facts, analyzing problems/identifying root cause recommending and facilitating resolution. Supports operations systems by providing operating information to customers; answering questions; providing training. Contributes to operations analysis and organization success by welcoming related, different, and new requests; helping others accomplish job results, development of Standard Operating Procedures (SOP) and other essential documentation, Verifies operations systems by...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: The Sr. Business Consultant ACA Individual serves as a strategic subject-matter expert responsible for designing, launching, and executing initiatives that advance organizational goals within the evolving healthcare landscape. This role is integral to driving ACA market growth by: Defining and implementing the ACA Operating Model and Playbook Partnering across matrixed teams to lead initiatives with the goal of increasing CareFirst market share, improving member/broker experience, and strengthening ACA Individual performance. Developing ACA dashboards to strengthen enterprise alignment with key performance indicators (KPIs) ESSENTIAL FUNCTIONS: Lead the development of the ACA Individual Operating Model and Playbook, ensuring clear end-to-end ownership of all ACA processes and alignment with defined KPIs, strategic priorities, and performance targets. Proactively identify, evaluate, and execute...

CareFirst BlueCross BlueShield Resp & Qualifications Territory for this role includes Cecil, Kent, Queen Annes and Talbot Counties. Ideal candidate should reside in one of these counties. PURPOSE: Develop and implement strategies and community events to engage with the community, promote services, and build relationships with stakeholders for CareFirst BlueCross BlueShield Community Health Plan Maryland (CHPMD). ESSENTIAL FUNCTIONS: Develop Outreach Strategies: Create and implement effective outreach strategies to promote CHPMD in Eastern Shore Maryland communities. Community Engagement: Establish and maintain relationships with community organizations, stakeholders, and the public to foster collaboration and support. Events: Work with community partners and attend (e.g. table, provide education workshop, present on CHPMD Medicaid benefits) a minimum of 10 events per month, workshops, and initiatives to raise awareness for CHPMD. Assist in planning CHPMD...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: The Business Consultant ACA Individual provides strategic, analytical, and operational expertise to support the design, launch, and execution of initiatives that strengthen ACA Individual market performance. This role contributes directly to CareFirsts ACA growth strategy by delivering insights, driving operational efficiencies, and supporting cross-functional alignment in a rapidly evolving healthcare environment. ESSENTIAL FUNCTIONS: Support the development of ACA dashboards in partnership with the external analytics vendor to segment member populations, identify cost-saving opportunities, and drive performance improvement. Leverage analytics to inform ACA marketing strategies by identifying priority populations and geographic segments. Collaborate with risk adjustment, care management, quality, and network teams to i improve coding performance and overall ACA member outcomes. Conduct competitive...

CareFirst BlueCross BlueShield Resp & Qualifications Summer Recruitment - MD/DC/VA This is a year-round internship. The ideal candidate is someone who can commit to work throughout the year (Spring/Fall - minimum 15-20 hours per week and 30-40 hours per week in the Summer). The anticipated start date for our Summer Cohort is late May or early June. The intern will be working with one of the actuarial team members to gain experience of actuarial Medicare work and understanding of the healthcare industry. You will have the opportunity to apply what you have learned in school within a business environment. This opportunity will allow you to develop valuable connections and relationships while working across multiple levels of management within different areas of the organization. PRINCIPLE ACCOUNTABILITIES: Gather data from different sources (Internal/External & Qualitative/Quantitative) Use your analytical skills to present findings (pivot tables,...

CareFirst BlueCross BlueShield Resp & Qualifications Summer Recruitment MD, DC, VA CareFirsts Strategic Growth division is accepting internship applications for our Summer 2026 program, spanning the companys marketing and communications, commercial sales, government programs, federal employee program, and strategic enablement functions.Through this internship program you will join a small team of driven, optimistic individuals seeking to improve healthcare - for our members and the world at large. Combining diverse backgrounds, viewpoints, life experiences, and skillsets we seek to be a proactive agent of meaningful change. We are not just reimagining healthcare for the future, we are actively transforming the way it is delivered, supported, and experienced today.We are looking for like-minded individuals who both share our mission of improving healthcare and remain humbled (if undaunted) by scale of the challenge. Whether your passion lies in distilling insights from...

CareFirst BlueCross BlueShield Resp & Qualifications Healthworx, the innovation and investment arm of Carefirst, is hiring a summer intern. This intern would be part of the Healthworx Ventures team, which mades Series A and Series B venture capital investments into healthcare companies. The Ventures team also manages a portfolio of venture captial investments, both direct companies and other funds in the healthcare space. Finally, the Ventures team is a classic experience in corporate venture capital and innovation: balancing the financial returns of a fund while also prioritizing strategic value in healthcare. As an intern on this team, you would have exposure to all elements of the Venture Capital process. You would join, and potentially take your own, sourcing calls with healthcare start-ups. You would network with other early stage investors and accelerators. Depending on active deals, you may support the diligence process. You would be involved in projects around...