146 jobs found in Baltimore, MD

CareFirst BlueCross BlueShield Resp & Qualifications CANDIDATES MUST BE LOCAL TO MD, DC, VA PURPOSE: The Clinical Advisor's role is multifaceted, involving data analytics, client facing presentations, and solutions optimization. The Clinical Advisor will extract relevant clinical data and educate clients, brokers, consultants, and internal stakeholders, showcasing the value of the organization's approach to managing care delivery. The Clinical Advisor will synthesize data and data trends to make individualized recommendations related to population health with a goal of improving outcomes and driving down cost in populations. The Clinical Advisor serves as key subject matter expert and strategic partner for the Sales team and will regularly attend onsite and virtual client meetings to review health outcomes and cost information. ESSENTIAL FUNCTIONS : Analyzes population health data as well as clinical and financial trends, for existing and prospect customer...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE : This intern position resides within the Business Development Team, part of the larger Enterprise Sales Division at CareFirst BlueCross BlueShield. 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 (35-40 hours) in the summer. The anticipated start date for this internship opportunity would be January 2026. This team is responsible for the development, management, and submission of all requests for proposal (RFPs) for new and existing business sales. The team works collaboratively with other business areas and subject matter experts (SMEs), including Sales Consultants and Underwriting across all products and offerings. PRINCIPAL ACCOUNTABILITES: Coordinate and prepare sales proposals Write responses to RFPs and questionnaires Distribute contact documents to SMEs...

Workday Your work days are brighter here. We're obsessed with making hard work pay off, for our people, our customers, and the world around us. As a Fortune 500 company and a leading AI platform for managing people, money, and agents, we're shaping the future of work so teams can reach their potential and focus on what matters most. The minute you join, you'll feel it. Not just in the products we build, but in how we show up for each other. Our culture is rooted in integrity, empathy, and shared enthusiasm. We're in this together, tackling big challenges with bold ideas and genuine care. We look for curious minds and courageous collaborators who bring sun-drenched optimism and drive. Whether you're building smarter solutions, supporting customers, or creating a space where everyone belongs, you'll do meaningful work with Workmates who've got your back. In return, we'll give you the trust to take risks, the tools to grow, the skills to develop and the support of a company...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: The Senior Business Analyst will have the responsibility to ensure that the business's need for changes to processes, policies and/or information systems are identified, understood, defined, documented and acted upon by eliciting, analyzing, documenting, validating, specifying and verifying the needs of business or user. The incumbent is accountable for the gathering and synthesizing of business requirements for moderate complexity software, systems, processes and/or services and translates them into specifications ensuring the business objectives are met. As the functional expert, the incumbent serves as a strategic conduit between the business area and the technical or software development team through which requirements flow. ESSENTIAL FUNCTIONS: Interprets business needs and issues by gathering, eliciting, creating, analyzing, documenting and validating the Business areas user and/or technical...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: This Behavioral Health Care Manager position will support members within the Medicare Advantage line of business. Under minimal supervision, the Care Manager researches and analyzes a member's behavioral health needs, along with related medical 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. We are looking for an experienced behavioral health clinician 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 or care provider location based on business needs and work activities/deliverables that week. ESSENTIAL FUNCTIONS: Identifies members with...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: The Representative, MSP COB I focus on Medicare Secondary Payer (MSP) claims, Coordination of Benefits (COB) Claims or both. Investigates Medicare Secondary Payer and/or COB cases to resolve quickly. Investigate and analyze Medicare Secondary Payer demands for coordination of benefits with Medicare. Update/maintain accurate file information regarding OPL to ensure correct coordination occurs with Medicare. Review case to determine primary liability. Researches claims history in order to identify previously paid claims. Determines liability based on timely filing guidelines and contractual benefits. Responds to Department of Treasury and various collection agencies both written and verbally. ESSENTIAL FUNCTIONS: Ensure requirements are followed for Medicare Secondary Payer. Investigate and analyze MSP reports for COB w/Medicare. Maintain Enrollment and OPL file information to ensure correct coordination...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: The Technician, Enrollment I is responsible for ensuring that members are accurately enrolled into CareFirst member enrollment systems in a timely manner, and according to the account contract or service agreement. To accomplish this, the associate in this role may interact and coordinate activity with key client account contacts, subscribers, CareFirst Sales, Underwriting, Finance, and Information Technology associates, as well as associates aligned to the Account Installation department of other BlueCross BlueShield Plans. ESSENTIAL FUNCTIONS: Enroll subscribers and dependents for all lines of business as requested via fax, U.S. mail, and/or e-mail. Verify enrollment status, make changes to membership records, research and resolve enrollment system discrepancies, process membership terminations, and other forms of enrollment events. Complete monthly reconciliation process and resolve discrepancies....

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: Manages the daily activities of a multi-functional operations area. Functional areas may include but not limited to: installation, implementation, client support, client services, client administration, customer service, enrollment and eligibility, claims processing, and call center operations. Investigates and settles claims or other customer service related issues not resolvable by lower staff members. ESSENTIAL FUNCTIONS: Achieves operational objectives by contributing information and analysis to strategic plans and reviews; preparing and completing action plans; implementing production, productivity, quality, customer-service standards; identifying and resolving problems; identifying, developing, and implementing system improvements. Meets departmental financial objectives by estimating requirements; preparing an annual budget; scheduling expenditures; analyzing variances; initiating corrective...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: This Behavioral Health Care Manager position will support members within the Medicare Advantage line of business. Under minimal supervision, the Care Manager researches and analyzes a member's behavioral health needs, along with related medical 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. We are looking for an experienced behavioral health clinician 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 or care provider location based on business needs and work activities/deliverables that week. ESSENTIAL FUNCTIONS: Identifies members with...

CareFirst BlueCross BlueShield Resp & Qualifications 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 developing testing methods; conducting and documenting tests. Improves operations analysis job knowledge by attending...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: The Lead Business Analyst will have the responsibility to ensure that the business's need for changes to processes, policies and/or information systems are identified, understood, defined, documented and acted upon by eliciting, analyzing, documenting, validating, specifying and verifying the needs of business or user. The incumbent is accountable for leading the gathering and synthesizing of business requirements for high complexity software, systems, processes and/or services and translating them into specifications ensuring the business objectives are met. As the functional expert, the incumbent serves as a strategic conduit between the business area and the technical or software development team through which requirements flow. ESSENTIAL FUNCTIONS: Interprets business needs and issues by gathering, eliciting, creating, analyzing, documenting and validating the Business areas user and/or technical...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: Investigate and perform adjustment of claims and ensure that claims are handled properly within authority limits, and in line with standard procedures and guidelines. Verifies insurance claims by reviewing claims requirements; examining documentation and calculations; highlighting and summarizing out-of-line situations; recommending changes in operating processes; completing reports, logs, and audit records. ESSENTIAL FUNCTIONS: Proactively investigate and perform adjustments of claims. Ensure claims are handled within authority limits, and in line with standard procedures and guidelines. Updates claims audit records by entering, verifying, and securing data. Settle standard/complex claims through payment or denial. Provides claims audit information and reports by collecting, analyzing, and summarizing data and trends. Improves claims adjustment job knowledge by attending training sessions...

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 Consultants do? The primary purpose of this role is to sell the company's industry leading pest management services and products to new and existing residential customers, while maintaining a customer-focused service to grow the business. You'll be the face of our national brand to your local community, and your clients will count on you to protect their homes and...

NJM Insurance Group Formal NJM Title: Distribution Representative - Maryland / Delaware Territory Department Name: Commercial Lines Sales Position Reports To: Administrator, CL Sales Job Location: Maryland market General Summary: Do you have a strong network with property and casualty insurance brokers in the greater Maryland / Delaware area? Do you have prior experience in Commercial Lines Sales, Commercial Lines Production Underwriting, or as a Broker Relationship Manager in Commercial Lines? If so, this is the perfect opportunity for you! This position offers a generous base of $86,000 to $100,000 (commensurate with relevant experience) with a quarterly and annual incentive opportunity that has the potential to add a significant amount to your total compensation annually. You are also eligible for our incredible benefits package, which includes a 401k with a dollar for dollar match up to 8% with immediate vesting and and an additional employer contribution...

American Red Cross Please use Google Chrome or Mozilla Firefox when accessing Candidate Home. By joining the American Red Cross you will touch millions of lives every year and experience the greatness of the human spirit at its best. Are you ready to be part of the world's largest humanitarian network? Join us-Where your Career is a Force for Good! Job Description: Joining The American Red Cross is like nothing else - it's as much something you feel as something you do. You become a vital part of the world's largest humanitarian network. Joining a team of welcoming individuals who are exceptional, yet unassuming. Diverse, yet uncompromising in unity. You grow your career within a movement that matters, where success is measured in people helped, communities made whole, and individuals equipped to never stop changing lives and situations for the better. When you choose to be a force for good, you'll have mentors who empower your growth along a purposeful...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: Defines, designs and develops system requirements. Performs trade-off analysis of performance, life-cycle cost, risk, producibility, and other system or program requirements. Assesses architecture and current hardware limitations, defines and designs system specifications, and evaluates input/output processes and working parameters for hardware/software compatibility. Coordinates design of subsystems and integration of total system. Defines system support requirements to include monitoring, capacity, staffing and patching/updating. Analyzes and resolves program support deficiencies. Conducts independent technical investigations in systems design. ESSENTIAL FUNCTIONS: Installs, tunes, upgrades, troubleshoots, and maintains all computer systems relevant to the supported applications including all necessary tasks to perform operating system administration, user account management, disaster recovery...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: Manages a team of technical engineers that manages daily operations of the department responsible for the design and engineering of the organization's infrastructure. Manages the administration of environments in multiple on-premises data centers, cloud infrastructure as well as disaster recovery. Ensure and maintain availability, performance, security, automation, DevOps, and license compliance of all infrastructure systems. Ensures that hardware and/or software are installed and optimally configured in best practice by the vendor and meets the needs of the organization. Monitors system performance and provides recommendations and executes engineering tasks, as needed. Responsible for creating and maintaining area's customer-based service level agreements. Responsible for mentoring staff and maintaining labor (talent retention), hardware and software budgets. ESSENTIAL FUNCTIONS: Oversees system...

Creative Circle VP/Director, Product Manager - Loan Origination Position Overview Our client is a large, consumer-focused financial services organization with a national footprint, serving millions of customers through a combination of digital and branch-based experiences. The organization operates in a highly regulated environment and is investing heavily in modernizing its core platforms to support long-term growth, scalability, and improved customer and team-member experiences. This project represents our client's most critical platform transformation, a multi-year, board-visible reset of the loan origination ecosystem. The initiative replaces decades-old legacy systems with a modern, scalable platform that will fundamentally change how team members serve customers. Our client is seeking a Vice President / Director of Product Management to lead the loan-origination transformation program. This leader will own end-to-end origination experiences with a strong front-end...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: Ensures the stability, integrity and efficient operation of the organization information systems that support organizational functions. This is achieved by monitoring, supporting and optimizing all networked software and associated operating systems. Assesses architecture and current system limitations, defines and designs system specifications, disaster recovery procedures and evaluates input/output processes and working parameters for hardware/software compatibility. ESSENTIAL FUNCTIONS: Installs, tunes, upgrades, troubleshoots, and maintains all computer systems relevant to the supported applications including all necessary tasks to perform operating system administration, user account management, disaster recovery strategy and networking configuration. Develop and implement techniques to prevent system problems, troubleshoots incidents to recover services and supports root cause analysis....