Capital Blue Cross

Director

• Lead the development and execution of a business innovation roadmap aligned to corporate strategy, administrative efficiency goals, customer experience priorities, and operational performance objectives
• Partner with senior leaders and business owners to identify high-value opportunities for process redesign, automation readiness, workflow improvement, self-service, and operational simplification
• Establish and manage a structured intake, and prioritization process for automation and innovation opportunities
• Guide business teams through discovery, current-state assessment, future-state process design, business requirements definition, pilot planning, implementation readiness, change management, and post-implementation measurement
• Translate operational pain points into clear business requirements and practical improvement opportunities
• Collaborate with IT&D, data and analytics, security, privacy, legal, compliance, HR and enterprise risk teams
• Develop and maintain performance dashboards and value realization reporting
• Identify opportunities to standardize processes, reduce manual effort, eliminate duplication, improve controls, and build scalable business practices across functions
• Build organizational capability by developing playbooks, toolkits, training, communication materials, and communities of practice
• Manage, coach, and develop direct reports or project-based resources
• Monitor external trends and emerging practices in automation, artificial intelligence, process improvement, customer service innovation, and operational model modernization

Senior Director, Business Innovation

Representative

• Manage telephone, electronic, and face-to-face interactions professionally and efficiently
• Present and discuss the products and services accurately to customers
• Focus on customer retention through first call resolution of concerns
• Maintain positive relationships with customers and take responsibility for their needs
• Support sales representatives by conducting educational meetings when business needs permit
• Complete ongoing training to stay updated on products and policies
• Recognize and alert supervisors of trends in customer calls

Member Services Representative

Network Engineer

• Perform contract administration activities including the preparation of contract settlements
• Ensure claims are paid in accordance with contract provisions and plan payment levels
• Perform research, analytic, and reporting work in support of Provider Contracting and Value Based Programs
• Work with team manager and other analysts to develop and administer contracts with healthcare providers
• Prepare provider contract settlements ensuring accuracy and compliance with payment provisions
• Manage Cost Rate Adjustment (CRA) process
• Respond to inquiries and resolve reimbursement issues from providers
• Develop proactive analytical studies on provider billing patterns

Network Contract Analyst

Systems Engineer

• Supporting department steady-state processing while assisting in the implementation of various projects
• Conducts reporting and analysis of financial data using various techniques
• Responsible for development, configuration, documentation, and support of internal and vendor financial applications
• Accountable for the maintenance and continuous improvement of Capital Blue Cross financial systems and processes

Health Plan Workday Financial Systems Analyst

Human Resources

• Design and apply change approaches that increase adoption of new processes, tools, behaviors, performance expectations, and ways of working.
• Conduct change impact and readiness assessments; translate findings into stakeholder engagement plans, communication inputs, leader actions, training needs, and reinforcement mechanisms.
• Support the continued evolution of performance enablement by helping leaders clarify goals, expectations, accountability, feedback routines, and measures of success.
• Serve as accountable day-to-day lead for assigned initiatives, including project planning, milestone tracking, issue resolution, stakeholder alignment, and executive-ready updates.
• Partner closely with HRBPs so solutions are grounded in business context and can be effectively introduced with leaders and teams.
• Use workforce data, survey results, performance indicators, adoption metrics, and stakeholder feedback to diagnose issues and evaluate whether initiatives are achieving intended outcomes.

HR Strategy Enablement Consultant

Accounts Payable

• Provides technical and administrative support to the Manager of the unit, Accounts Payable personnel, as well as internal and external customers.
• Participates in planning unit goals.
• Provides unit training and creates and maintains documentation.
• Performs month end close activity.
• Provides statistical reports to all levels of plan personnel.
• Assists in application and procedural testing.
• Voids and reissues all appropriate payment documents paying special attention to ensure their recording in the appropriate accounting period.
• Monitors the bank transmissions, and ensures payments meet all deadlines.
• Fills in and performs essential job functions during absences of any unit personnel.
• Coordinates regular unit meetings, maintaining agenda and recording minutes.
• Oversees the processing and payment schedule for all invoices and employee reimbursements.
• Coordinates alternative payment schedules, and ensures all payments meet deadlines.
• Performs the month end close, as well as monitors the weekly journal import to the general ledger.
• Responsible for researching discrepancies and responding to inquiries regarding coded invoices as related to budget versus actual variances.

Technical Assistant – Accounts Payable

Strategy

• Leads the CX Insights and Market Research function
• Owns and evolves the enterprise Voice of the Customer (VoC) strategy
• Directly leads and executes high-impact research initiatives
• Defines and governs enterprise customer and member journey frameworks
• Drives prioritization of CX opportunities
• Establishes CX insights standards, methodologies, and governance
• Oversees end-to-end research strategy and execution
• Translates insights into executive-ready recommendations
• Leads vendor strategy and research portfolio management
• Partners with senior leaders and develops team members

Manager, CX Insights – Strategy

General

• Collaborate with members, family, healthcare providers, community resources, and other members of the healthcare team to coordinate services
• Identify, facilitate, and secure access to needed healthcare, social services benefits, and community resources
• Assist members with navigating the steps along the path to efficient and effective care
• Actively monitor calls, conduct outgoing calls, and respond to voice mail requests in a timely manner
• Identify and assess members’ medical, behavioral, social, emotional, and financial needs
• Conduct health education
• Build relationships with members, their families, and caregivers

Health Navigator, LPN

• Support Capital Blue Cross' financial services department
• Combine financial systems analysis, development, and reporting to support business strategies
• Act as liaison between technical support teams and operational accounting teams
• Develop, configure, document, and support internal and vendor financial applications
• Conduct reporting and analysis of financial data

Health Plan Financial Systems Analyst – Workday

Content Writer

• Lead the development of strategic sales communications
• Take ownership of developing RFPs, sales resources, and other strategic communications from kickoff to final delivery
• Coordinate with Sales and other business units to gather input, write persuasive narratives, and ensure high-quality, timely submissions
• Partner with subject-matter experts to write targeted, compelling, and timely content for various channels
• Research, write, and edit succinct, engaging content including newsletters, customer presentations, and internal training resources
• Coordinate and create thoughtful, thorough responses to RFIs
• Collaborate and contribute with subject-matter experts to strategize on effective ways to position Capital’s products and services
• Own and manage the RFP database to ensure content is accurate, current, and easily accessible

Proposal & Marketing Writer

Data Engineer

• Manage the assignment, workflow, and oversight process to ensure quality, consistency, and timeliness of deliverables from data engineers
• Create and maintain standards for data design, modeling, and deployment in Snowflake
• Provide direction and training to data engineers regarding foundational applications used in the development lifecycle
• Assess new data ingestion patterns to improve efficiency and timeliness of data availability
• Define data delivery strategy and monitor data release schedule
• Provide guidance to data analyst community on best practices for leveraging and querying new data assets
• Interpret business needs from requests, and rapidly implement effective technical solutions that meet long term objective of providing consistent data delivery across enterprise
• Create and maintain ETL Source to Target mapping documents, data playbooks, and data flow inventory documents

Manager, Data Engineering

Project Manager

• Manage large multi-faceted projects or multiple projects simultaneously
• Organize teams, develop plans, and facilitate project execution
• Raise issues and risks with transparency
• Mentor peers in project management principles
• Collaborate with project teams for effective project health reviews
• Ensure projects are consistently closed within 45-60 days of go-live

Customer Support

• Provides administrative support to assigned clinical team, as directed by the Team Lead and/or Manager
• Assist with medical record documentation requests and leverages medical management system to initiate case and/or authorization to support clinical processes (e.g. UM, CM)
• Conducts fax and telephonic outreach; and written communications to members and/or providers to communicate status of UM/CM processes (e.g. verbal notification, engagement status, discharge plan)
• Supports administrative functions with community events (e.g. health fairs)
• Accurately documents all interventions in the member’s medical management record in accordance with established policies and procedures
• Actively participates in supporting department compliance and performance through administrative activities such as report monitoring/distribution, and other tasks as assigned by leadership
• Adheres to all regulatory and compliance standards, including adherence to all Capital and department specific policies and procedures
• Interacts courteously and professionally with customers, including internal staff, vendor partners, providers, and members to support collaborative medical management functions
• Identifies and reports potential quality of service/care issues as established and within the guidelines of intradepartmental processes
• Promotes personal growth through participation in staff meetings, appropriate in-services, and corporate training
• Identifies opportunities and proposes alternatives for improving the Population Management functions

Clinical Support Specialist

Pharmacist

• Provide leadership, direction and oversight for pharmacy sales and account management
• Develop and implement strategies relating to Pharmacy sales and account management
• Responsible for developing, implementing and maintaining a strategic pharmacy sales and customer relations approach for our brokers, groups, and members
• Responsible for ensuring that our customers’ and members’ expectations around pharmacy are matched by our corporate and divisional strategies and goals
• Develop and direct the formulation and implementation of short and long-range strategies in support of Capital’s pharmacy sales growth and retention goals
• Responsibilities will include responding to Requests for Proposals (RFP’s)
• Help integrate pharmacy benefit management into our Health Plan Business by serving as the external Subject Matter Expert for pharmacy benefits
• Responsible for the management of staff and resources including hiring, development, coaching and counseling and annual performance reviews for direct reports
• Partner with PBM Sales team (new and renewal) to monitor opportunities and deliver results

Manager, Pharmacy Account Support

Accounting Manager

• Records daily/monthly Miscellaneous Invoices for Capital Blue Cross and Subsidiaries within Workday
• Verifies the accuracy of the General Ledger coding provided prior to creating the invoice
• Generates and distributes invoices, weekly aging reports and statements to internal and external personnel
• Responsible for the daily tracking and recording of Alternate Payee Affidavits into an Access Database
• Communicates verbally or in writing with Capital's banks as needed in regard to bank statements, bank adjustments, forgery affidavits and other related documents