Capital Blue Cross

Consultant

• Serves as a primary interface between clinical services and other departments to ensure multi- and inter-disciplinary vendor project coordination.
• Participates in communication and project planning regarding other company/department initiatives.
• Collaborates with clinical department directors and other key staff in overall project evaluation.
• Identifies key benchmarks for use in evaluation.
• Initiates and directs planning related to project development including identification of project objectives, expected outcomes, resource requirements and evaluation strategies.
• Assists clinical department directors and other in the interpretation and use of data for decision-making.
• Applies clinical knowledge and use of healthcare data to drive decisions.
• Present information to help organization leaders understand clinical impact of data to drive healthcare quality improvement.
• Improves and innovates the use of technology within clinical practice and workflows.

Clinical Vendor Consultant

Manager

• Responsible for the coordination of services for members who meet established criteria
• Uses a collaborative process to assess Member needs, review options for services and resources, develop and implement a plan of care
• Monitor progress, evaluate Member status, discharge Members, and fully document the individualized member care management process and outcome
• Provide counseling and referrals to community/local/state programs; collaborate with caregivers, providers, community agencies, behavioral health, and other resources to coordinate care

RN Care Manager

IT Support

• Provide technical support to the Plan's end user community in the use of available Desktop Services products
• Provide remote or on-site support for desktops, laptops, mobile devices, telephones, printers, video conferencing, asset management systems
• Maintain consistent quality and conform to written standards in all manner of work
• Operate in a manner which seeks out issue resolution, using data, reporting, and automation
• Provides support in areas of monitoring and maintaining systems, applications, assets, and updates
• Develop and Maintain Automation of Processes and Procedures on all platforms and systems
• Maintain knowledge of technology through research and attendance at vendor seminars

IT Support Specialist II – Microsoft 365, Intune

Security Engineer

• Monitor and analyze security events using SIEM tools to detect and respond to threats in real-time
• Investigate security incidents, perform root cause analysis, and document findings for remediation and reporting
• Manages the full vulnerability lifecycle across enterprise systems, including identifying security weaknesses, assessing and prioritizing risk, coordinating remediation efforts, and validating that issues are resolved
• Works closely with IT and business teams to ensure vulnerabilities are addressed in a timely manner based on risk, impact, and relevant threat intelligence
• Analyze logs from endpoints, servers, network devices, and cloud platforms to identify suspicious activity
• Support incident response activities including containment, eradication, and recovery
• Manage vendor security assessment reviews to enable informed decision-making related to third party engagements
• Participate in threat hunting activities to proactively identify hidden threats in the environment

Information Security Specialist

Director

• Lead the strategy, design, governance, and continuous evolution of the company’s compensation and rewards programs
• Oversee compensation philosophy, job architecture, job evaluation, salary structures, incentive plan design, pay transparency readiness, market benchmarking, and reward-related transformation initiatives
• Lead the ongoing development and refinement of Capital’s compensation and rewards philosophy
• Translate philosophy into practical program design, salary administration guidelines, incentive frameworks, and decision-making tools for leaders
• Recommend innovative, modern approaches to compensation and rewards that support a high-performance culture, stronger accountability, and enterprise success
• Lead the design, evaluation, and administration of short-term and sales incentive plans, variable pay programs, and other reward mechanisms
• Ensure incentives are clearly linked to business goals, strategic priorities, measurable outcomes, and the right employee behaviors
• Assess plan effectiveness using data and analytics, and recommend changes to improve performance differentiation, line of sight, competitiveness, and return on investment
• Direct compensation benchmarking, market analysis, and pay modeling to support hiring, retention, organizational design, promotion, and executive decision-making
• Provide insight and recommendations to senior leaders on market trends, emerging pay practices, regulatory developments, and risks
• Lead transformational compensation and rewards projects from strategy through implementation, including process redesign, technology enablement, communications, and change management
• Serve as a trusted advisor to senior HR leaders and business leaders on complex compensation matters, incentive design, and reward strategy

Director, Compensation Strategy

Systems Engineer

• Work with a cross-functional team on large scale projects
• Identify potential projects risks and contingencies
• Elicit and document detailed business requirements to support system and process changes for cross-functional projects
• Considers root cause analysis and identifies process improvement opportunities
• Apply practical application and industry knowledge to decision making and strategic initiatives
• Make complete technical and business process recommendations including ROI, estimated time required and other documentation that supports the project life cycle
• Serve as liaison between business process experts and technology experts in order to elicit business requirements and translate to technical teams
• Develop the test strategy and planning documents
• Coordinate and communicate test strategy to project sponsors, and management
• Ability to serve as a Test Lead on complex projects and provide test execution support as needed
• Ability to write test plans and enter into defined testing tools
• Assign testing tasks as needed to project testers
• Monitor activities assigned to testers and ensure testing is completed by the due date
• Review and coordinate testing with business areas
• Communicate test status and milestones to department and project management

Senior Business Systems Analyst

• Lead end-to-end audits of provider charge masters, billing practices, and associated claims to evaluate billing accuracy, rate structures, and adherence to contractual and regulatory requirements
• Design and enhance audit frameworks, models, dashboards, and templates that standardize audit execution and support enterprise provider audit functions
• Evaluate audit findings and exercise professional judgement to determine materiality, recovery potential and recommended resolution strategies
• Lead or support provider discussions related to audit findings, including explaining methodologies, defending determinations, and recommending corrective actions or process improvements
• Maintain current knowledge of CMS guidelines, payer policies, and healthcare billing standards
• Recommend process improvements, charge containment strategies, and policy changes to ensure appropriate billing and reimbursement practices
• Drive proactive analytical studies to assess changes in provider billing patterns, charge description masters and other variable reimbursement provisions
• Provide technical guidance, mentoring, and quality oversight to Provider Audit Specialists

Senior Provider Audit Specialist

Data Analyst

• Analyze data to assist in the design of our Value Based Programs (VBP) - including accountable care arrangements, medical neighborhoods, and other value-based Initiatives.
• Work with senior business analyst to develop analytic and/or report requirements that support their ability to make informed decisions regarding strategy initiatives/objectives, and/or appropriate tactical level actions.
• Intake queries from physician practices related to reports and process flows associated with VBP and initiatives (i.e., provide first line of support), refine requirements and coordinate responses from informatics and reporting resources.

Medical Value Systems Data Analyst II

• Support the overall success of the Government Programs (GP) Division
• Support the implementation of new products and benefit enhancements of existing products
• Responsible for planning, developing and improving operational workflows
• Lead implementation cycles, updating/tracking annual timelines
• Provide oversight of operational support systems in support of GP performance goals
• Ensure compliance accuracy and ensure products meet requirements/expectations of external and internal customers
• Development and oversight of implementation activities from CMS and state application and regulatory filings through product launch and the entire product life cycle
• Manage cross-segment projects and initiatives that require problem solving, relationship building, influencing and analyzing
• Partner with various departments to ensure effective product offerings meet the division's strategic priorities

Government Programs Consultant

• Analyze data to assist in the design of our Value Based Programs (VBP) - including accountable care arrangements, medical neighborhoods, and other value-based Initiatives.
• Work with senior business analyst to develop analytic and/or report requirements that support their ability to make informed decisions regarding strategy initiatives/objectives, and/or appropriate tactical level actions.
• Work within the Network Analytics and Pricing (NAP) Unit to help identify, research, and resolve operational and other business issues relating to the value-based programs and initiatives.
• Intake queries from physician practices related to reports and process flows associated with VBP and initiatives (i.e., provide first line of support), refine requirements and coordinate responses from informatics and reporting resources.
• In collaboration with informatics and reporting functional areas and information technology experts, assist in establishing self-service tool requirements that allow for the efficient production of reports and analyses.