32 director product strategy jobs found

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: Join our team to lead the creation of CareFirsts next-generation Integration Platform, seamlessly blending API-first design with a product-based approach to advance our cloud-native strategy. Play a pivotal role in transforming how we operate, enabling faster innovation, streamlined execution, and cost-effective solutions that scale across our Enterprise Portfolio. CareFirst is undertaking a digital transformation which requires enterprise agility paired with the retooling of our technology stack to speed-up delivery and to expand our reach. The Digital Factory organization is leading this charge by advancing our Scaled Agile Framework (SAFe) ways of working across the organization. To drive this transformation, the Platform Engineering Manager is a key role within the Integration & Interoperability team that builds technical depth, expertise, and resource management within the Nexus platform....

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: Manages end-to-end oversight of the Stored Information Retrieval (SIR) system and related operational processes including front-end mail room services, document scanning and digital record storage related to member and provider submitted paper claims, correspondence, appeals, finance checks, enrollment forms and provider credentialing forms. Drives teams and internal projects to maintain and enhance program performance over time. Guides stakeholders through key decisions, communicates and coordinates activities internally and across departments. Facilitates process improvement and identifies and articulates stakeholder needs to drive strategies and maximize outcomes related to ROI, customer satisfaction, and organizational metrics and performance. Takes full ownership of all components of program from day to day tasks to building road maps, driving strategy and leading organization wide initiatives...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: Performs advanced actuarial and oversight skills in the performance of actuarial analytics to develop actionable items in support of departmental goals Provides actuarial leadership support to Medical, Pricing, Underwriting, Sales, Finance and other applicable Business Units. Responsible for actuarial modeling to support financial objectives. and making recommendations to executives and senior management. ESSENTIAL FUNCTIONS: Responsible for directing the efforts of Actuarial staff (Pricing, Actuarial Finance, Actuarial Medicare Advantage, Actuarial Innovation and Research) to accomplish near and long-term goals set by senior management. In collaboration with senior management, responsible for setting long term strategy within the Actuarial department. Responsible for representing the Actuarial department to internal and external customers including state and federal regulators. Hiring, recruiting...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: Executes medium to complex sourcing projects, from start to finish. This role will rationalize the supply base through strategic sourcing, lead cross-functional team to achieve optimal total cost of ownership, identify cost savings opportunities across the company, support overall supply requirements and ensure an effective spend analysis for assigned category. ESSENTIAL FUNCTIONS: Provides sourcing services (RFx, reverse auctions, negotiations) to clients based on predefined service levels, managing 5-12 simple to complex projects simultaneously with limited supervision/guidance or independently. Executes sourcing strategy by leading formal sourcing processes including stakeholder engagement, RFP processes and contract negotiations. Assists in the development of category sourcing strategy leading cross-functional teams to execute the sourcing strategy. Partners with customer groups to establish...

CareFirst BlueCross BlueShield 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...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: This position maty be responsible for preparing analyses associated with the development of reimbursement policy, strategies, cost of care impacts and work flows for healthcare providers' reimbursement fee levels. The incumbent will work with various commercial and government program related fee schedules, develop recommendations and prepare competitive analyses to include industry, regional, and internal benchmarks. Will be responsible for reviewing and analyzing information for various provider reimbursement and network strategy projects, preparing routine reports and fee disclosure related documents. Knowledge of Medicare or Medicare Advantage products preferred. We are looking for an experienced professional to live and 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...

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: Provides leadership that drives strategic vision of the Company's financial systems, including the ERP and EPM systems and the suite of applications that connect to those. This role will work with the Finance and IT leadership teams and other business partners to develop and continually maintain an innovative future-state roadmap for financial systems and processes taking into account business priorities and strategic objectives. This role will collaborate with the leadership teams across the organization on applications strategy and in building out key capabilities and services to support the organization. Responsible for driving innovation in a fast-paced rapid growth environment, delivering software solutions that meet or exceed customer and stakeholder expectations in a manner that optimally leverages technology. ESSENTIAL FUNCTIONS: Responsibility for support and maintenance of our Finance...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: Performs complex analysis, design, development, 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, develops/codes, tests, and documents critical and complex application programs for computer systems. Works with appropriate stakeholders to define system scope and objectives and establish baselines. Establishes project standards and processes. Breaks down software requirements and creates highly complex systems. ESSENTIAL FUNCTIONS: Perform technical detail design, coding, testing of applications. Serves as subject matter expert for both customer and internal discussions related to maintaining and enhancing existing software systems. Develop and/or analyze interface design documentation. Comply with hardware and software systems standards and procedures. Deliver large...

CareFirst BlueCross BlueShield Resp & Qualifications Join our Platform team to play a key role in shaping CareFirsts next-generation Integration Platform, with a strong emphasis on MuleSoft as a cornerstone of our future-state architecture. This role drives innovation, defines technical strategy, and champions developer enablement to accelerate adoption of an API-first, product-based integration approach. By leveraging MuleSofts platform capabilities, you will help streamline execution, enable reusability, and deliver scalable, cost-effective solutions that power our enterprise portfolio. CareFirst is undergoing a digital transformation that demands enterprise agility and a modernized technology stack to increase speed-to-market and broaden our impact. The Integration & Interoperability organization is at the forefront of this shift, advancing Scaled Agile Framework (SAFe) practices across the enterprise. As a Sr. Platform Engineer, you will lead MuleSoft platform...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: The Risk Adjustment Manager plays a critical role in the development and execution of the corporate risk adjustment strategy. The role serves as a dedicated resource within the organization for Medicare Advantage, Medicaid and ACA markets, coordinating and leading the end to end strategy by applying improvements and driving cost-effective risk adjustment actions across all organizational populations and products. ESSENTIAL FUNCTIONS: Proactively create, manage and communicate Risk Adjustment related encounter or submission KPIs, OKRs, ROI, action plans, progress and risks within organizational teams. Develop and manage tracking tools, dashboards, and metrics for monitoring the progress of the encounter integrity and submission accuracy in collaboration with cross-functional teams and senior leadership. Conduct impact analysis and formulate actions related to all risk adjustment-related regulatory...

CareFirst BlueCross BlueShield Resp & Qualifications Although this position is remote, candidates must live in the MD, DC, VA area in order to travel into the offices on occasion. PURPOSE: The Client Onboarding Manager (OM) serves as the primary point of contact for new clients and provides them with an excellent experience throughout the onboarding lifecycle. The OM works directly with the Sales Team to ensure a smooth transition of new customers. Responsible for guiding new clients through their first 90- 120 days of implementation by creating and delegating tasks to appropriate stakeholders, managing those tasks to their completion, maintaining the implementation schedule, leading efforts in identifying potential risks and resolving challenges, and providing transparent communication to all stakeholders. The OM is an advocate for new clients to ensure needs are met. Solely responsible for the overall success of new business implementations, setting and managing...

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. 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...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: The Small Group Existing Business Sales Consultant serves as the primary strategist and revenue leader for a defined territory of small group brokers, and their associated employers. Unlike traditional account service roles, this position will not manage day-to-day broker service issues those are handled by the Broker Service Team. Instead, the consultant is responsible for retention strategy, renewal positioning, revenue optimization, and broker ecosystem engagement. This role mirrors the strategic expectations of our manager-level sales leadership: driving clarity, elevating performance, and ensuring our market voice is consistent, compelling, and effective. The consultant functions as the internal authority on the assigned relationships the person the broader organization turns to for insights on portfolio health, competitive threats, renewal decisions, and growth strategy. ESSENTIAL FUNCTIONS:...

CareFirst BlueCross BlueShield Resp & Qualifications (Live in CareFirst service area) 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 contracts, reimbursement methods, documentation and amendments, and participate in internal workgroups and committees, ensuring compliance and advising on business strategies. ESSENTIAL FUNCTIONS: Contract Development and Negotiation Serves as a consultant and subject matter expert (SME) in contracting and...

CareFirst BlueCross BlueShield Resp & Qualifications CANDIDATES MUST LIVE IN THE MD, DC, NORTHERN VA AREA IN ORDER TO TRAVEL INTO THE OFFICES AND FOR CLIENT MEETINGS AND STAFF MEETINGS. PURPOSE: This position is responsible for renewing/growing a book business which includes the most complex and jumbo accounts with indemnity and managed care medical products, ancillary/specialty products, and life products. This position drives revenue and manages current and prospective relationships to ensure success with products. Leads sales initiatives and strategies within their assigned territory. Achieves sales and profitability objectives by effectively managing new and existing accounts. ACTIVE HEALTH AND LIFE LICENSE IS REQUIRED. ESSENTIAL FUNCTIONS: Ensures that each assigned account renews annually and aggressively pursues growth within groups by developing and implementing account specific benefit and financial strategies. Manages and develops a set of...

CareFirst BlueCross BlueShield Resp & Qualifications CANDIDATES MUST LIVE IN THE MD, DC, NORTHERN VA AREA IN ORDER TO TRAVEL INTO THE OFFICES AND FOR CLIENT MEETINGS AND STAFF MEETINGS. PURPOSE: This position is responsible for renewing/growing a book business which includes more complex accounts with indemnity and managed care medical products, ancillary/specialty products, and life products. You will be working with Public Sector accounts with various funding arrangements and plan sponsors within state, municipal and school boards ranging in girth from 100 to 100,000+ contracts. This position drives revenue and manages current and prospective relationships to ensure success with products. Leads sales initiatives and strategies within their assigned territory. Achieves sales and profitability objectives by effectively managing new and existing accounts. ACTIVE HEALTH AND LIFE LICENSE IS REQUIRED. ESSENTIAL FUNCTIONS: Ensures that each assigned account...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: We are seeking a Senior Technical Program Manager to lead cross-functional programs that modernize the enterprise data ecosystem, advance interoperability capabilities, and drive the retirement of legacy platforms. This role will oversee the end-to-end delivery across architecture, engineering, governance, IT partners, and business stakeholders to ensure scalable, compliant, and future-ready data solutions. ESSENTIAL FUNCTIONS: Program Leadership & Execution: Own multi-year roadmaps for enterprise data modernization, interoperability capabilities, and legacy system decommissioning. Manage complex cross-domain programs spanning multiple technical domains and platforms, establishing milestones, identifying risks and dependencies, and coordinating transparency through dashboards, KPIs, and executive updates. Legacy System Retirement: Lead structured deprecation programs for legacy and redundant...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: Your role involves managing the entire lifecycle of enterprise data products and services to align with company goals. You will lead the strategic direction of data products and coordinate teams of business leaders, data engineers, data architects, data analysts, and data scientists. As a Data Product Manager, you will establish and execute the data product operating model, define the vision and strategy for data products, implement product management processes, and produce roadmaps for high-quality, high-performing data products. You will also deliver data solutions that enhance the analytical experiences of CareFirsts customers and internal teams. You create value from the organization's data assets and enable internal/external analytics and insights. This includes developing strategies to achieve business outcomes, drive innovation, and ensure compliance with regulatory, legal, and ethical...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: Performs advanced actuarial and management skills in the support of departmental and company objectives. Oversees and directs the work of Actuarial staff and represents the Actuarial department to senior and executive management of multiple business areas. Serve on Taskforces and ensures that all information is accurately and effectively utilized. ESSENTIAL FUNCTIONS: Responsible for directing the efforts of Actuarial Staff (Pricing, Actuarial Finance, Actuarial Medicare Advantage, Actuarial Innovation and Research) to accomplish near and long-term goals set by senior management. In collaboration with senior management, responsible for setting long term strategy within the Actuarial department. Responsible for representing the Actuarial department to internal and external customers including state and federal regulators. Hiring, recruiting and developing a purpose-driven, growing team with balanced,...