129 jobs found in Baltimore, MD

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: Develops and implements security solutions. Administers security technology systems. by architecting and engineering/developing trusted systems into secure systems. Assists in the development of implementation and deployment plans that are aligned to the organizational strategic plan objectives and security requirements. Advises management in developing cybersecurity policies, processes, and procedures. ESSENTIAL FUNCTIONS: Manage Splunk Cloud app and add-on deployments within FedRAMP boundary constraints, coordinating with Splunk support where cloud admin controls are limited: Respond to and resolve customer tickets related to data ingestion issues, search performance, access requests, and platform health. Administer user roles, access controls, and index permissions in alignment with HIPAA and FedRAMP compliance requirements. Maintain accurate documentation for all configurations, deployments,...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: Shape and execute reporting strategy for data collected. Help drive critical business decisions by analyzing metrics and designing reports. Communicate results to stakeholders and provide suggestions based on findings. ESSENTIAL FUNCTIONS: Collaborates with stakeholders to understand data needs to create reports that meets the needs of the business. Identifies functional requirements through process analysis, review of documents and procedures, and interviews and meetings with stakeholders. Occasionally works alongside Developers and the System Architects to use the requirements to design the system concept of operations from both business and technical perspectives. Analyzes data and develops observations and findings based on analysis. Creates and test reports utilizing feedback and revisions into reporting products. Conducts quality control, communicates findings, and obtains sign-off from...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: The Marketing Technology & Insights Intern will support Marketing Technology (MarTech) initiatives focused on data strategy and platform enablement, while also assisting with enterprise survey research efforts led by the Insights team. Approximately 75% of this role will focus on MarTech responsibilities, including marketing systems, data flows, and platform evaluation. The remaining 25% will support survey research initiatives that inform marketing, experience, and business decisions across audiences. This is a year-round internship opportunity. We are looking for students who can commit to our work up to 15-20 hours per week during the academic year in the Fall/Spring and 35-40 hours per week during the Summer. The start date for the internship will be May 18th or June 1st. ESSENTIAL FUNCTIONS: 75% Marketing Technology (Data Strategy & Platform Enablement) Support marketing data...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: This entry level position is responsible for the attainment, effective management, and profitability of a designated book of business. This position utilizes underwriting judgment and exercises a level of authority. Pricing concessions are permitted up to the designated level of authority without further review. This position works closely with Sales and Account Management to ensure that client needs are met ESSENTIAL FUNCTIONS: Works closely with the Account Manager and Underwriting Manager to provide alternate benefit plans, risk and/or funding arrangements. Update appropriate billing rate files, contracts, internal databases, etc. Complete the renewal process on smaller accounts, complete/update ASO and Stop Loss contracts and quote alternate funding arrangements with assistance from senior underwriter, consultant or management. Support attainment of corporate sales and profitability goals...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: The Digital Marketing Project Manager Provider & Member Engagement leads the planning, execution, and optimization of digital communications across email, web, SMS, and mobile-first channels. This role manages campaigns that support both member and provider audiences, ensuring timely, compliant, and engaging communications that align with organizational goals and customer experience strategies. ESSENTIAL FUNCTIONS: Manage end-to-end project delivery for mobile engagement/SMS, email, and web campaigns targeting both member and provider audiences. Develop project plans, timelines, budgets, and resource allocations for lifecycle, operational, and promotional communications. Coordinate with cross-functional teams including marketing, provider relations, business areas, clinical teams, compliance, analytics, product, and IT. Oversee campaign workflows from intake and strategy through build,...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: Responsible for the attainment, effective management, and profitability of a designated book of business. This position utilizes underwriting judgment and exercises a level of authority. Pricing concessions are permitted up to the designated level of authority without further review. This position works closely with Sales and Account Management to ensure that client needs are met without compromising the corporate objectives. This position is responsible for monitoring financial performance and apprising management as needed. Responsibilities also include pharmacy related underwriting functions, such as evaluating pharmacy benefit structures, reviewing high-cost drug utilization and trends, assessing risk tied to specialty medications, and collaborating with Pharmacy Benefits Management (PBM) partners to ensure appropriate pricing, risk mitigation, and compliance. ESSENTIAL FUNCTIONS: Ensure the...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: Develops and implements security solutions. Administers security technology systems. by architecting and engineering/developing trusted systems into secure systems. Assists in the development of implementation and deployment plans that are aligned to the organizational strategic plan objectives and security requirements. Advises management in developing cybersecurity policies, processes, and procedures. ESSENTIAL FUNCTIONS: Manage Splunk Cloud app and add-on deployments within FedRAMP boundary constraints, coordinating with Splunk support where cloud admin controls are limited: Respond to and resolve customer tickets related to data ingestion issues, search performance, access requests, and platform health. Administer user roles, access controls, and index permissions in alignment with HIPAA and FedRAMP compliance requirements. Maintain accurate documentation for all configurations, deployments,...

Rentokil North America Benefits Start Day 1 for Full-Time Colleagues - No Waiting Period! For more information about our benefits, see below! We are proud to be a member of the Rentokil family of companies, the global leader in Pest Control and other services across more than 90 countries. We pride ourselves on being a trusted partner to many of the world's leading brands and serve consumer and business customers across multiple industries. We are extremely proud of our legacy of excellence and constantly work to fulfill our mission to "protect people, enhance lives, and preserve the planet." What do our Regional Account Executives do? As a Regional Account Executive your assignment will include prospecting for new clients with the objective of selling our industry leading pest elimination solutions. The Regional Account Executive will be calling on a full spectrum of market segments including hospitality, food & beverage processing, healthcare, retail, and...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: The intern is an integral member of the Product Management Team, part of the larger Enterprise Strategy and Development Division at CareFirst BlueCross BlueShield. This team is responsible for the product lifecycle of CareFirsts Commercial, Government, 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...

CareFirst BlueCross BlueShield Resp & Qualifications MD-DC-Northern VA PURPOSE: Under minimal supervision, the Care Manager researches and analyzes a member's medical and behavioral health needs and healthcare cost drivers. The Care Manager works closely with members 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. This position will support the Federal Employee Program line of business. We are looking for an experienced professional to work remotely from within the greater Baltimore/Washington DC metropolitan areas. The incumbent will be expected to come into a CareFirst location periodically for meetings, training and/or other business-related activities. ESSENTIAL FUNCTIONS: Identifies members with acute/complex medical and/or behavioral health conditions. Engages onsite and/or telephonically with members, family and providers...

CareFirst BlueCross BlueShield Resp & Qualifications Maryland/ DC/ Northern VA PURPOSE : Under minimal supervision, the Care Manager researches and analyzes a member's medical and behavioral health needs and healthcare cost drivers. The Care Manager works closely with members 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. This position will support the Federal Employee Program line of business. We are looking for an experienced clinician to work remotely from within the greater Baltimore/Washington DC metropolitan areas. The incumbent will be expected to come into a CareFirst location periodically for meetings, training and/or other business-related activities. 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: This is a Year-Round Internship. We are looking for students who can commit to work up to 15-20 hours per week during regular business hours (M-F 8-5PM) for the academic year in the Fall/Spring and 35-40 hours per week during the summer. Motivated and detailed CRM intern to join the Large Group Commercial Market Account Management Team. This internship will get hands on experience in the health insurance industry, supporting our team in managing client relationships, driving sales initiatives, and contributing to the growth of our business. PRINCIPLE ACCOUNTABILITIES: Support the team in addressing client inquiries and ensuring client satisfactionAssist in researching client inquiriesDevelop an understanding of the health insurance industry including benefit & mandate requirements for fully insured, self-insured, and Medicare Advantage groupsReview and analyze benefit plan...

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 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...