32 consultant jobs found in Washington, DC

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: The Sr. Business Consultant ACA Individual serves as a strategic subject-matter expert responsible for designing, launching, and executing initiatives that advance organizational goals within the evolving healthcare landscape. This role is integral to driving ACA market growth by: Defining and implementing the ACA Operating Model and Playbook Partnering across matrixed teams to lead initiatives with the goal of increasing CareFirst market share, improving member/broker experience, and strengthening ACA Individual performance. Developing ACA dashboards to strengthen enterprise alignment with key performance indicators (KPIs) ESSENTIAL FUNCTIONS: Lead the development of the ACA Individual Operating Model and Playbook, ensuring clear end-to-end ownership of all ACA processes and alignment with defined KPIs, strategic priorities, and performance targets. Proactively identify, evaluate, and execute...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: The Business Consultant ACA Individual provides strategic, analytical, and operational expertise to support the design, launch, and execution of initiatives that strengthen ACA Individual market performance. This role contributes directly to CareFirsts ACA growth strategy by delivering insights, driving operational efficiencies, and supporting cross-functional alignment in a rapidly evolving healthcare environment. ESSENTIAL FUNCTIONS: Support the development of ACA dashboards in partnership with the external analytics vendor to segment member populations, identify cost-saving opportunities, and drive performance improvement. Leverage analytics to inform ACA marketing strategies by identifying priority populations and geographic segments. Collaborate with risk adjustment, care management, quality, and network teams to i improve coding performance and overall ACA member outcomes. Conduct competitive...

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 CANDIDATES MUST LIVE IN THE DC/VA AREA IN ORDER TO TRAVEL FREQUENTLY INTO THE OFFICES AND TO ATTEND CLIENT MEETINGS. A CURRENT HEALTH AND LIFE LICENSE IS REQUIRED PURPOSE: This position is responsible for new business development within the Mid-Market space. This role leads sales initiatives and strategies as well as relationship building with both our external partners and prospects as well internal constituents. The sales consultant position requires a deep level of knowledge and understanding of selling to self-insured customers with complex benefit arrangements. In addition, the role requires having experience and excellent presentation skills in meeting with C-suite prospects as well large consultant practices. ESSENTIAL FUNCTIONS: Achieve sales goals and profitable growth for the organization. Position and sell multiple lines of coverage, medical, stop loss, dental and vision. Strategize on...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: The Population Health Strategy Consultant works closely with physicians and health systems ("providers") enrolled in CareFirst's commercial and government value-based programs to understand patterns in their population's health data and effectuate practice transformation strategies that improve quality and reduce global health care costs. The Practice Consultant collaborates with internal subject matter experts to provide consulting services to physicians, key physician practice staff, executive level health system administrators, and other stakeholders to achieve program or contract goals. Participates in senior level peer workgroups to research and suggest new best practices and workflows to enhance the success of the consulting team. 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...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: This role is responsible for developing new business opportunities and/or retain existing business within the Federal Markets Division. This position represents the organization in acquisition strategy development, prospecting in the Federal Government and using consultative selling skills in order to grow new business and/or retain existing business and enhance profitability. ESSENTIAL FUNCTIONS: Aggressively grow new business and/or renew existing business for medical and ancillary products in the federal market segment. Ensure appropriate update of Sales strategy/sales activities documentation on a monthly basis. Develop strong Agency Benefits Officer relationships utilizing advanced strategic and consultative skills both in person and through electronic communication. Provide documented formal training of assigned Agency Benefits Officers throughout the year including the use of virtual...

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 CANDIDATES MUST LIVE IN THE MD, DC, VA AREA IN ORDER TO TRAVEL INTO THE OFFICES AND FOR CLIENT MEETINGS AND STAFF MEETINGS. CURRENT HEALTH & LIFE LICENSE IS REQUIRED 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. TPA experience preferred. 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...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: This position will play a pivotal role in the modernization and redesign of the utilization management department within the Health Services division. The Sr. Business Consultant provides expertise in tailored, strategic, and critical work to help design, launch, and execute programs that support initiatives in the changing healthcare industry. Using a deep understanding of utilization management, the Senor Business Consultant acts as a liaison between the UM clinical teams, the technical support teams, and the claims operations teams. Ensures alignment of authorization to claims processing by use of a working knowledge of claims system configuration, including claims edits. The ideal candidate will have a deep understanding of proper plan design across all commercial and government programs plans and experience administering plans in a large payer organization. We are looking for an experienced...

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. ACTIVE HEALTH AND LIFE LICENSE IS REQUIRED. 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. 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. ESSENTIAL FUNCTIONS: Ensures that each assigned...

Aledade The Enterprise Data Architect is a strategic leadership role responsible for the design and evolution of Alledade's Master Data Management (MDM) strategy and the architecture of our Business Data Warehouse. This role addresses the critical challenge of linking fragmented data across the customer lifecycle-from initial prospecting in Salesforce to contract management in Ironclad, through to operational and financial setup in Keystone, NetSuite, and QuickCap. As a Level 8 leader, you will move the organization away from manual, siloed data entry toward an automated, unified "Single Source of Truth." By leveraging our existing investments in Snowflake, DataHub, and MuleSoft, you will design the framework that allows the Business Intelligence (BI) team to extract high-value insights regarding revenue, performance, and overall organizational success. Primary Duties Enterprise Data Strategy & MDM Design MDM Architecture: Design the strategy and logical architecture...

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...

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...

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 career...

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 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 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...

Apex Systems, Inc. Job#: 3024332 Job Description: For an immediate response, please send to [email protected] : WORD resume/Security+ CE, desired hourly rate, and best time to speak! Job ID : 3024332 Position : Secret Cleared Data Center Engineer Location : Joint Base Andrews, MD Duration : Long Term Contract MUST HAVE: Ability to obtain and maintain a Secret Clearance | Security+ CE Experience managing and/or standing up a Data Center Description : Position opening for a Data Center SME to provide technical leadership and support in the areas of IT planning, solution specification/design, implementation and target architecture development for a Consolidated Communication Center (CCC). The qualified candidate will have knowledge of information technology commercial solutions and experience designing and developing technical solutions in order to lead the design and development of cutting-edge, scalable, and energy-efficient data...

Transamerica Job Family Financial Accounting & Reporting 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...

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...