99 welding jobs found

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: Supports Pharmacy Quality clinical teams by assisting with non-clinical administrative tasks and responsibilities related to care coordination, member outreach, and provider/pharmacy engagement to improve Quality measure performance related to Pharmacy. Although this position is REMOTE, candidates are preferred to live in the MD, DC, VA area in order to travel into our local offices. ESSENTIAL FUNCTIONS: Assists with member follow up and coordination of care that does not require intervention from a clinician (refilling prescriptions; finding appointments; calling providers and pharmacies; arranging services, etc.), enabling clinicians to perform at the top of their license. Screens, and/or prioritizes members using targeted intervention business rules and processes to identify needed services. Transitions to appropriate clinical resources/programs as necessary. Provides general support and...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: Responsible for answering member, provider & broker inquiries pertaining to product information, benefits, claims resolution, eligibility and billing questions in a call center environment. Proactively provides information and education to members, providers & brokers, as appropriate, about a variety of health, financial, and self-service programs. Provides basic technical assistance and troubleshooting guidance for digital and electronic applications. ESSENTIAL FUNCTIONS: Provides first- level problem resolution to member, provider and broker inquiries via telephone by gathering and researching information; examine claim submissions verifying claim and system accuracy as well as liability, validate customer understanding of information and resolves issues based on applicable policies and procedures. Uses knowledge of products or services by collecting and the contractual provisions that...

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 Clinical Appeals Nurse completes research, basic analysis, and evaluation of member and provider disputes regarding adverse and adverse coverage decisions. The Clinical Appeals Nurse utilizes clinical skills and knowledge of all applicable State and Federal rules and regulations that govern the appeal process for Commercial and Federal Employee Programs lines of business in order to formulate a professional response to the appeal request. ESSENTIAL FUNCTIONS: Investigates, interprets, and analyzes written appeals and reconsideration requests from multiple sources including applicants, subscribers, attorneys, group administrators, internal stake holders and any other initiators. Responds to such requests with original letters, complex and technical in nature, upholding corporate policies and decisions while meeting all State and Federal regulations and mandates. Organizes the appeal case for...

CareFirst BlueCross BlueShield 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,...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: Configures, tests and documents configuration solutions for provider reimbursement configuration set-up and maintenance, benefit package configuration setup and maintenance, membership configuration set-up and maintenance, setup of code sets used for configuration in benefits & pricing for claims processing, claims editing configuration set-up and maintenance. Analyzes business requirements and objectives towards determining the optimal configuration of the requirements. Creates complex design documents through the assessment of requirements. Assesses alternatives to different designs and chooses best solution to fit business needs. Performs complex data modeling and database design with minimal oversight. Ability to multitask while prioritizing projects. ESSENTIAL FUNCTIONS: Independently performs hands-on configurations, workflow and process mapping in Guiding Care for core care management and...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: Configures, tests and documents configuration solutions for provider reimbursement configuration set-up and maintenance, benefit package configuration setup and maintenance, membership configuration set-up and maintenance, setup of code sets used for configuration in benefits & pricing for claims processing, claims editing configuration set-up and maintenance. Analyzes business requirements and objectives towards determining the optimal configuration of the requirements. Creates complex design documents through the assessment of requirements. Assesses alternatives to different designs and chooses best solution to fit business needs. Performs complex data modeling and database design with minimal oversight. Ability to multitask while prioritizing projects. ESSENTIAL FUNCTIONS: Independently performs hands-on configurations, workflow and process mapping in Guiding Care for core care management and...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: Serves as a senior authority over Product Owners and product teams, ensuring strategic alignment and clarity. Leverages extensive expertise to lead and manage complex project requirements, introducing innovative tools and best practices. Oversee the development of products to meet the needs of both internal and external clients, establishing and communicating the business value of their development and implementation. Offers strategic insights and guidance on opportunities and risks, supporting clients with informed decision-making. ESSENTIAL FUNCTIONS: Leads the development of two or more product portfolios and provides workable solutions to satisfy customer and market expectations in close collaboration with stakeholders, Product managers, product Owners, and scrum teams. Collaborates with senior leaders to identify and plan product releases by reviewing milestones with stakeholders; manages the...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: The Appeals Specialist I is responsible for the initial analysis of appeals and/or grievance correspondence, and determination of next steps for Commercial and FEP lines of business. Responsible for collecting, organizing and tracking information to facilitate and expedite processing of appeals and/or grievances received from a variety of sources. We are looking for an experienced professional 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: Prioritize, research and analyze all pertinent information in preparation of an appeal and/or grievance request. Access the appropriate database to implement accurate and timely entry of appeal, grievance and/or reconsideration correspondence and updates the appropriate referral...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: The Disaster Recovery Principal is responsible for the overall management, strategy, and execution of CareFirsts Disaster Recovery (DR) program. This individual contributor role works closely with a managed services provider and internal stakeholders to ensure the resilience and recoverability of CareFirsts critical and non-critical business applications and infrastructure. The position oversees the development, maintenance, and execution of DR policies, standards, procedures, and exercises, ensuring compliance with regulatory requirements and alignment with organizational objectives. The role is expected to drive innovation by leveraging AI, automation, and cloud-native technologies to enhance disaster recovery capabilities and future-proof the organizations resilience strategies. ESSENTIAL FUNCTIONS: Program Management & Innovation Establish and maintain core DR program policies, standards,...

CareFirst BlueCross BlueShield Resp & Qualifications We're hiring for a Data Scientist- ID/STRAT and Program Evaluation on the Health Economics and Reporting team at CareFirst! PURPOSE: Identifies and solves business problems by using various numerical techniques, algorithms, and models in statistical modeling, machine learning, operations research, and data mining. Uses advanced analytical capabilities to support data science initiatives. Communicates across product teams and with customers and educates on artificial intelligence, machine learning, and statistical models. Acting as a liaison and interface between analytics, business units and other departments. We are not looking for generalists who may have an IT background and various credentials like Scrum, Agile, etc. 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...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: We're hiring for a Manager, Data Analytics - Value-Based Care Reporting on the Health Economics and Reporting team at CareFirst! Purpose of the Manager, Data Analytics is to execute business objectives with data and ensure alignment with the vision of the company. Individual will organize the technology, processes and financial resources necessary to address the current and future analytics needs of the business. Provides thought leadership and acts as a subject matter expert in the designing and recommending of appropriate analytical approaches and methodologies. Provides management responsibility into data-driven insights that inform the business's strategic direction. 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...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: Provides strategic and tactical planning, as well as, knowledge services relating to the implementation of key mandate initiatives, covering a broad range of legislative and regulatory matters including: Federal, BCBSA, Government Programs, State. Provides internal and external liaison functions, workflow, customer service, communications, training, strategic delivery, efficiency, cost reduction and skill development initiatives. We are looking for an experienced professional to work remotely. The incumbent will be expected to come into a CareFirst location periodically for meetings, training and/or other business-related activities. ESSENTIAL FUNCTIONS: Analyzes legislation and regulations as it relates to CareFirst and creates high level compliance requirements. Primary/dedicated Regulatory point of contact for Project Managers who implementation projects. Takes a lead role in various...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: Identifies and solves business problems by using various numerical techniques, algorithms, and models in statistical modeling, machine learning, operations research, and data mining. Uses advanced analytical capabilities to support data science initiatives. Communicates across product teams and with customers and educates on artificial intelligence, machine learning, and statistical models. Acting as a liaison and interface between analytics, business units and other departments. We are not looking for generalists who may have an IT background and various credentials like Scrum, Agile, etc. 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...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: Identifies and solves business problems by using various numerical techniques, algorithms, and models in statistical modeling, machine learning, operations research, and data mining. Uses advanced analytical capabilities to support data science initiatives. Communicates across product teams and with customers and educates on artificial intelligence, machine learning, and statistical models. Acting as a liaison and interface between analytics, business units and other departments. We are not looking for generalists who may have an IT background and various credentials like Scrum, Agile, etc. 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...

Ehrlich 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 Pest Control Technicians do? The primary purpose of this role is to perform our industry leading pest management services for residential customers. You will be responsible for identifying and eliminating pests from residential properties by conducting thorough inspections, determining the type of pest infestation, applying appropriate treatments like pesticides and traps, and...

Alkermes, Inc. Territory Business Manager (TBM) is responsible for selling Alkermes products in the Bethesda territory and supporting promotional efforts. Ideal candidates should be proven sales achievers and live in the territory. This will be done by having thorough product, disease state and market knowledge and sound selling skills. He/she will utilize available resources to help educate healthcare providers. Finally, he/she will use their analytical ability to determine appropriate targets and will use approved resources accordingly. Responsibilities The TBM will demonstrate a strong understanding of all aspects of Alkermes products, related disease states and related products in the marketplace The TBM will demonstrate strong selling skills through the use of approved sales aids, approved studies and reprints and through superior communication and listening skills with targeted healthcare providers. He/she will use selling skills that demonstrate competent use of all...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: The Onsite Clinical Navigator (RN) embedded at a partnering hospital will conduct concurrent review of inpatient level of care, managing the timely and smooth transition from inpatient care to home or other levels of care. Utilizing experience and skills in both care management and utilization management, the Onsite Clinical Navigator will leverage proficiency in established MCG, in addition to administrative/regulatory considerations, to determine medical necessity, appropriate level(s) of care and case management to engage members/enrollees, their families and other support systems in discharge planning. The role will function as a liaison working onsite at the assigned hospital up to 5 days per week and occasional weekend work may also be required, both at management's sole discretion. Such work will be conducted with the hospital care team including case managers, social workers and discharge planners...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: The Data Engineer, working within the Finance Data Systems and Decision Support area, is a highly motivated professional responsible for developing innovative and complex data solutions and applications to support actuarial analytics specializing in medical economics. With a critical eye towards data integrity and a growing understanding of claim and provider data, the Data Engineer will work closely with actuaries to produce trend analytics tools and dashboards and assist with ad hoc reporting and analysis. Additionally, the Data Engineer will partner with actuaries to support the financial impact analysis related to the building of and changes to Government Program analytics. The Data Engineer is expected to have a basic understanding of the health care business and is strongly encouraged to quickly improve on this business knowledge to perform analysis more independently on the data to validate accuracy...