19 legal jobs found in Baltimore

McGuireWoods Job Description: The Baltimore office of McGuireWoods seeks an Associate to join its Financial Services and Securities Enforcement Department. The cornerstone of McGuireWoods' financial services and securities enforcement group is the team's ability to effectively represent the interests of the vital, growing and increasingly complex financial services sector. This representation includes securities, lender liability, regulatory issues, loan workouts, foreclosures, class actions and credit card-related matters. Lawyers' experience encompasses the expanding services offered by financial institutions, including recent cases involving securities fraud, failed asset securitizations and defaulted syndicated loans. The firm also represents banks in connection with commercial disputes, business torts and intellectual property matters. McGuireWoods, one of the world's leading law firms, has provided legal solutions to corporate, individual and nonprofit clients since...

Transamerica Job Family Corporate Development, Strategy and Sustainability About Us At Transamerica, hard work, innovative thinking, and personal accountability are qualities we honor and reward. We understand the potential of leveraging the talents of a diverse workforce. We embrace an environment where employees enjoy a balance between their careers, families, communities, and personal interests. Ultimately, we appreciate the uniqueness of a company where talented professionals work collaboratively in a positive environment - one focused on helping people look forward and plan for the best life possible while providing tools and solutions that make it easier to get there. Who We Are We believe everyone deserves to live their best life. More than a century ago, we were among the first financial services companies in America to serve everyday people from all walks of life. Today, we're part of an international holding company, with millions of...

Transamerica Job Family Operational Risk About Us At Transamerica, hard work, innovative thinking, and personal accountability are qualities we honor and reward. We understand the potential of leveraging the talents of a diverse workforce. We embrace an environment where employees enjoy a balance between their careers, families, communities, and personal interests. Ultimately, we appreciate the uniqueness of a company where talented professionals work collaboratively in a positive environment - one focused on helping people look forward and plan for the best life possible while providing tools and solutions that make it easier to get there. Who We Are We believe everyone deserves to live their best life. More than a century ago, we were among the first financial services companies in America to serve everyday people from all walks of life. Today, we're part of an international holding company, with millions of customers and thousands of employees...

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...

Transamerica Job Family Actuarial About Us At Transamerica, hard work, innovative thinking, and personal accountability are qualities we honor and reward. We understand the potential of leveraging the talents of a diverse workforce. We embrace an environment where employees enjoy a balance between their careers, families, communities, and personal interests. Ultimately, we appreciate the uniqueness of a company where talented professionals work collaboratively in a positive environment - one focused on helping people look forward and plan for the best life possible while providing tools and solutions that make it easier to get there. Who We Are We believe everyone deserves to live their best life. More than a century ago, we were among the first financial services companies in America to serve everyday people from all walks of life. Today, we're part of an international holding company, with millions of customers and thousands of employees...

McGuireWoods Job Description: The Baltimore office of McGuireWoods seeks a Financial Regulatory Associate to join its Financial Services and Securities Enforcement Department. The cornerstone of McGuireWoods' financial services and securities enforcement group is the team's ability to effectively represent the interests of the vital, growing and increasingly complex financial services sector. This work includes advising clients in cutting-edge payments products, state and federal regulatory inquiries, rulemakings, money transmission, lobbying and legislative affairs, licensing, product counseling, intellectual property, and compliance obligations across domestic and international markets. McGuireWoods, one of the world's leading law firms, has provided legal solutions to corporate, individual and nonprofit clients since 1834. Along with excellent benefits, McGuireWoods offers our attorneys a competitive salary with hours and merit bonus opportunities and billable hours...

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: 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 lines of business in order to formulate a professional response to the appeal request. 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: Investigates, interprets, and analyzes written appeals and reconsideration requests from multiple sources including applicants, subscribers, attorneys, group administrators, internal stake holders and any other...

Transamerica Job Family Regulatory Compliance About Us At Transamerica, hard work, innovative thinking, and personal accountability are qualities we honor and reward. We understand the potential of leveraging the talents of a diverse workforce. We embrace an environment where employees enjoy a balance between their careers, families, communities, and personal interests. Ultimately, we appreciate the uniqueness of a company where talented professionals work collaboratively in a positive environment - one focused on helping people look forward and plan for the best life possible while providing tools and solutions that make it easier to get there. Who We Are We believe everyone deserves to live their best life. More than a century ago, we were among the first financial services companies in America to serve everyday people from all walks of life. Today, we're part of an international holding company, with millions of customers and thousands of...

CareFirst BlueCross BlueShield Resp & Qualifications CANDIDATES MUST LIVE IN THE MD, DC, NORTHEN VA AREA IN ORDER TO TRAVEL INTO THE OFFICES AND FOR CLIENT MEETINGS AND STAFF MEETINGS. ACTIVE HEALTH AND LIFE LICENSE IS REQUIRED. PURPOSE: As a key member of our Account Management Team, the Account Manager II plays a pivotal role in driving client success and business growth. This position combines strategic consulting, relationship management, and marketing expertise to deliver exceptional value to our clients. Youll serve as a trusted advisor, promoting our suite of benefits and services, and leading initiatives that enhance client satisfaction, increase enrollment, and strengthen long-term partnerships. ESSENTIAL FUNCTIONS: Drive Growth & Engageme nt: Lead the charge in growing group enrollment by marketing directly to client associates. Plan and execute impactful communication and education strategies that resonate with diverse employee...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: The Vendor Management Manager is responsible for driving key business relationships with critical business partners, managing global partner issues, and working with internal teams such as Information Technology to ensure understanding of customer and business needs. This position will contribute to enhancing and optimizing the processes and workflows established between CareFirst and contracted vendors. In addition, the Vendor Management Manager will hold vendors accountable for contracted performance guarantees to ensure members receive the highest quality of service and ensure financial compliance to contracts. This role will manage a stable of vendors in the Information Technology space. ESSENTIAL FUNCTIONS: Responsible for overseeing the vendor management process including supervision and monitoring of Division vendor performance. Responsible for ensuring processes are in place to monitor vendor...

McGuireWoods Job Description: The Baltimore office of McGuireWoods seeks a Mid-level Associate to join its Public Finance Practice Group. McGuireWoods' nationally recognized Public Finance Practice Group within the firm's Public and Private Infrastructure & Real Estate Department guides clients through all types of tax-exempt and taxable financings for non-profit, higher education, for-profit, energy infrastructure, healthcare and similar clients. We help clients navigate all aspects of a financing or refinancing, including reviewing, drafting or analyzing underlying credit support, tax, construction and management agreements; drafting and negotiating all financing and offering documents, certificates and opinions; and reviewing and analyzing complex federal tax issues. Our work with public and private clients in the healthcare, energy, higher education, waste-to-energy, recycling, governmental, and industrial industries solidifies our reputation as a top national firm for...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: The Paralegal III position is an advanced position for an experienced paralegal with subject matter expertise in a designated specialty area of the law, such as litigation (plaintiff and/or defense), with a focus on regulatory, compliance and employment law, providing advanced support to the attorneys in the organization and to other Divisions or Departments as directed by counsel. ESSENTIAL FUNCTIONS: Work in Specialized Area of Expertise: Proactively, monitor and manage compliance with statutory and regulatory requirements in the area of expertise, including investigating and researching complex legal matters, collecting and compiling information and documents and either timely responding to, or proposing draft responses to legal correspondence for counsels final review. Draft documents, including proposing responsive pleadings or other legal documents for counsel, compile, update, and manage all...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: To support the prevention, reduction of and/or recuperation of losses to CareFirst through the clinical review of medical records and claims, resulting in the savings and/or recovery of funds. Responsible for providing clinical knowledge to the SI team to support both prepayment reviews and/or post-payment investigations. ESSENTIAL FUNCTIONS: Review of medical records and claims. Investigate potential fraud and over-utilization by performing complex medical reviews of claims and medical records. The claims may be in a pre or post payment environment. Provide a detailed but concise analysis to communicate findings about the ability to pay or deny a claim or claim lines using clinical and/or coding, billing, or reimbursement knowledge. Maintain appropriate records and supporting documentation regarding findings in accordance with departmental standards. Process all assigned claims or batch case reviews...

CareFirst BlueCross BlueShield Resp & Qualifications CANDIDATES MUST LIVE IN THE MD, DC, NORTHEN VA AREA IN ORDER TO TRAVEL INTO THE OFFICES AND FOR CLIENT MEETINGS AND STAFF MEETINGS. ACTIVE HEALTH AND LIFE LICENSE IS REQUIRED. PURPOSE: This position is a critical resource within the Account Management Team providing consultative expertise on benefits, products, and capabilities. Responsible for promoting new and existing products or services through the development and delivery of tactical marketing and communication initiatives. The Account Manager is directly responsible for aggressively growing group enrollment by marketing to the client's associate base. Builds and maintains effective long-term relationships and a level of satisfaction with key senior-level decision makers and influencers assigned to a group of strategic clients. Creates demand for the organization's products and services by successfully managing the internal and external client...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: The Pharmacy Supply Chain Director is responsible for leading critical financial and analytic functions within the Pharmacy Management department. This role ensures the organization maximizes contractual value by overseeing reconciliation of pharmacy rebates and network discounts with the PBM and medical rebates with Synergies, delivers timely and accurate rebate and discount calculations to self-insured ASO/CFA accounts, and builds, maintains, and enhances enterprise pharmacy data and analytics capabilities ESSENTIAL FUNCTIONS: Pharmacy Supply Chain (Pharmacy & Medical Rebate Reconciliation): Lead the end-to-end reconciliation of all pharmacy rebates, network discounts, and medical rebates to ensure contractual financial guarantees are met. Interpret multiple complex contract terms, conditions, definitions, and financial guarantees, translating them into claim-level mapping and reconciliation...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: Manages end-to-end oversight of Pharmacy initiatives. 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 pharmacy strategies and maximize outcomes related to ROI, customer satisfaction, and organizational metrics and performance. ESSENTIAL FUNCTIONS: Manages complex pharmacy program(s) or strategic initiatives that span organizational boundaries and have a significant legal and/or financial impact to CareFirst Business. Identifies process improvement opportunities and takes action to implement enhancements to maximize outcomes and growth. Coordinates with internal and external stakeholders to launch, maintain, and enhance complex pharmacy program(s)....

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: This role manages the appeal process for members and providers who appeal on behalf of members for Commercial lines of business. Ensures quality management of the clinical appeal process to reduce the risk of State and Federal Regulatory fines and sanctions, avoid adverse exposure, reiterate the expectation of a fair and compliant appeal process for our membership, and support NCQA accreditation and the Divisional Goals for Care Management. We are looking for an experienced clinical leader in the greater Baltimore 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. ESSENTIAL FUNCTIONS: Develops, establishes and implements a compliant appeal process with dynamic goals resulting in the full and...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: The Payment Integrity Analyst is responsible for conducting research and analysis and reviewing billing requirements, provider manuals, medical policies, and other sources as needed to identify new overpayment concepts, as well as validate all prospective and retrospective overpayment results; communicating findings to the Payment Integrity Workgroup and Management. The incumbent will be responsible for assessing and implementing new technology and recommend improvement to existing processes. In addition, they will be responsible for providing thorough analysis on their findings. ESSENTIAL FUNCTIONS: Identifies, develops, and implements new concepts that will target claim overpayment scenarios. Performs analysis on claims, provider data, enrollment data, medical policies, claim payment policies for payment integrity concepts for recovery opportunities. Performs analysis of business unit data and...