Capital Blue Cross

Manager

• The Care Manager is responsible for the coordination of services for members who meet established criteria, with an emphasis on education/self-management and promoting quality care and cost-effective outcomes.
• The Care Manager uses a collaborative process to assess Member needs, review options for services and resources, develop and implement a plan of care, coordinate resources, monitor progress, evaluate Member status, discharge Members, and fully document the individualized member care management process and outcome.
• The Care Manager will address medical, psychosocial, clinical needs, and behavioral health needs including members with mental health and substance use disorder needs.
• Care Managers provide counseling and referrals to community/local/state programs; collaborate with caregivers, providers, community agencies, behavioral health, and other resources to coordinate care to achieve member’s optimal health status.
• The Care Manager is responsible for the management and oversight of a caseload of moderate - high risk Members with complex medical/behavioral /psychosocial needs.

RN Care Manager – Maternity

Human Resources

• Develop and maintain influential relationships with leadership to drive talent outcomes that support business objectives.
• Assess organizational performance systemically and define talent gaps.
• Provide proactive HR support, managing all aspects of the employee lifecycle.
• Partner with business leaders and Finance on regular workforce planning data management.
• Serve as a resource and advise on general policy application and process/practice implementation.
• Conduct stay interviews and exit interviews to identify trends and issues.
• Facilitate annual talent and succession planning events.

Senior HR Business Partner

Analyst

• Perform contract administration activities encompassing preparation of contract settlements to ensure that claims are ultimately paid in accordance with the provisions of the contracts
• Perform research, analytic and reporting work in support of the Provider Contracting and Value Based Programs ACA agreements, provider reimbursement strategies and new contracting initiatives
• Work with team manager and other analysts to develop and administer contracts between Capital BlueCross and various providers
• Assist in developing an annual plan for the team which considers available resources and anticipated workload
• Responsible for the analytical functions necessary to effectively administer provider contracts
• Prepare provider contract settlements ensuring accuracy
• Manage the Cost Rate Adjustment process
• Respond to questions and concerns raised by providers
• Participate in drafting contracts for new and existing providers
• Develop proactive analytical studies to assess changes in provider billing patterns and charge description masters
• Perform audit functions on the work of others in the Provider Operations unit

Network Contract Analyst

Affiliate Manager

• Serve as the primary point of contact for the CIO, managing complex calendars, meetings, travel, external visitors, and executive logistics.
• Proactively manage meeting cadence and priorities to ensure time is focused on the highest-impact technology and business initiatives.
• Prepare agendas, briefing materials, and pre-reads for ELT, Board, and technology leadership meetings.
• Attend select leadership, operating, and governance meetings as a partner to document minutes, decisions, and action items.
• Ensure participants are prepared in advance and accountable for follow-ups and commitments.
• Anticipate needs and ensure the CIO is fully prepared for meetings, presentations, and enterprise communications.
• Handle sensitive and confidential information with the highest level of discretion.
• Manage budget tracking and oversee contracts and vendor engagements as delegated by the CIO.
• Partner with the CIO to track strategic priorities across IT, Digital, Data, Security, and transformation initiatives.
• Maintain dashboards, trackers, and action logs for key initiatives, risks, and dependencies.
• Drive follow-up with leaders and teams to ensure commitments are met without requiring the CIO to chase updates.
• Support preparation of executive-level materials including Board updates, leadership presentations, operating reviews, and strategic readouts.
• Act as project manager for CIO-sponsored initiatives and special projects.
• Coordinate timelines, stakeholders, dependencies, and deliverables across technology and business teams.
• Build strong relationships across IT and business functions to facilitate communication and alignment.

Executive Programs Partner – Assistant

• Responsible for day-to-day coordination, leadership, and strategy of the Pharmacy Member Outreach arm of the Medicare Pharmacy team
• Oversee the PBM Care Team performance
• Prioritize daily, weekly, monthly focus of PBM Care Teams and Member Outreach team
• Clear oversight and formal assessment of PBM Care Team performance
• Manage personnel issues, including hiring, training, staff performance reviews, and facilitating staff development activities.

Manager, Pharmacy Stars and Member Outreach

Data Analyst

• Analyze large datasets to identify trends, patterns, and insights related to coding output, with a focus on improving quality.
• Take ownership of complex data workflows by building and maintaining scalable analytics pipelines using data tools such as SQL, SAS, and Snowflake.
• Leverage technical expertise to streamline recurring and/or ad-hoc analyses into reusable, scalable data products.
• Collect, interpret, and aggregate data from multiple sources to support risk adjustment, medical record coding, government audits, and quality initiatives.
• Support the development of risk-related policies, procedures, and governance strategies, identifies opportunities to improve processes and efficiency, and delivers actionable insights through enterprise reporting and analytics tools such as SQL, SAS, Snowflake, and Power BI.

Senior Healthcare Data Analyst – Risk Adjustment, Medicare & ACA

Sales

• Responsible for supporting the Vice President, Sales Strategy and Growth in developing the overall Sales Strategy
• Owns the responsibility for developing and advancing the strategic interests of Commercial Group, Retail Services, and specialty products
• Develop an annual strategic sales plan, coordinating execution, membership forecast, analysis of results
• Coordinates between business segments to monitor expected EOY results and communicates to senior leadership
• Leads team to develop incentive programs based on profitability for Capital Blue Cross

Manager, Sales Strategy and Incentives

Risk

• Analyze large datasets to identify trends, patterns, and insights related to coding output
• Take ownership of complex data workflows by building and maintaining scalable analytics pipelines
• Collect, interpret, and aggregate data from multiple sources
• Support the development of risk-related policies, procedures, and governance strategies

Senior Risk Adjustment Analyst, Medicare

Medical Director

• Conduct coverage reviews based on individual member plan benefits and national and proprietary coverage review policies.
• Document clinical review findings, actions and outcomes in accordance with policies, and regulatory and accreditation requirements.
• Engage with requesting providers as needed in peer-to-peer discussions.
• Make medical necessity determinations on appeals and grievances, assuring that different reviewers conduct each level of review.
• Support organizational accreditation efforts and regulatory review processes.

Medical Director – Utilization Management

Data Engineer

• Design and maintain scalable cloud-based data pipelines and models to support reliable data products
• Hands-on ELT development, data quality assurance using the Audit, Balance, Control (ABC) framework
• Consultative collaboration with analysts and stakeholders
• Build, refactor, and maintain pipeline components of data products for a cloud environment
• Analyze large and complex datasets for quality, accuracy, anomalies, and performance
• Own pre-UAT testing for every change using the standard ABC framework
• Assess project-specific integration restrictions/options and recommend load strategy, storage targets, and data access layer model

Data Engineer II

Software Engineer

• Provide strategic direction and oversight to teams focused on analysis, development and configuration, while ensuring alignment with organizational priorities.
• Lead departmental and cross-functional corporate initiatives to optimize business processes, systems, and solutions.
• Serve as project sponsor/owner, as appropriate, and engage teams/staff for implementation and ongoing support.
• Drive transformation from waterfall to agile methodologies, building agile capabilities and fostering a culture of continuous improvement.
• Oversee modernization efforts, eliminating technical configuration debt and implementing best practices for configuration management.
• Provide oversight for vendor relationships, negotiations, and contract oversight.
• Champion automation and AI adoption to enhance operational efficiency and business outcomes.
• Build strong relationships with business stakeholders and technical leaders to drive innovation and consensus.
• Mentor and develop team leaders and staff, fostering accountability and professional growth.
• Manage budgets, resources, and performance metrics for all sub teams.
• Ensure effective communication and collaboration between sub teams and executive leadership.
• Stay abreast of industry trends, regulatory changes, and emerging technologies.

Senior Director, Business Engineering

Business Analyst

• Ensure accuracy and integrity of all pharmacy data
• Collaborate with pharmacy staff, clinical teams, and business leaders to gather, document, and analyze business requirements
• Identify inefficiencies and opportunities for process optimization within pharmacy operations
• Serve as a liaison between business units and IT teams
• Develop key performance indicators (KPIs) and analytics to track success of technology implementations
• Support execution of projects by assisting in project planning and timelines
• Create user manuals and conduct training sessions
• Assist in the configuration of pharmacy technology solutions and provide first-level technical support

Pharmacy Technical Business Analyst

Support Engineer

• Handle all customer inquiries through multiple channels
• Conduct research and provide problem-solving support
• Provide efficient, courteous service to customers
• Ensure compliance with organizational and regulatory requirements

Client Services Pharmacy Support Analyst

Salesforce Developer

• Obtain firsthand experience with Agile Methodologies and Scrum Ceremonies
• Learn about the different Salesforce Clouds and functionalities
• Gain experience and knowledge by shadowing Salesforce Technical Business Analysts, Software Engineers, and Administrators
• Acquire necessary knowledge and skills to follow developer guidelines and deployment processes per our standards
• Collaborate cross-functionally to complete development work in Salesforce per business requirements and use cases

Salesforce Solutions Intern

Network Operations

• Responsible for the day-to-day support needed from Network Operations, which includes Credentialing, Provider Data, Provider Support and Provider Innovations
• Managing vendor invoicing against budgeted allowances
• Analyzing service level agreements against contract terms and invoice payments
• Primary responsibility with provider data verification and support provider attestation and access availability outreach to support NCQA and other regulatory needs
• Coordinates department policies and procedures, updating documents as needed
• Supporting stake holder inquiries related to SharePoint issues
• Acts as Access Coordinator, including new hires, changes in positions or removing access as necessary
• Coordinates the Provider Manual updates as necessary for Network Operations, MyCare Finder user guide and Provider Maintenance user guide
• Serves as a primary interface between internal departments to ensure multi and inter disciplinary vendor project coordination