CareFirst BlueCross BlueShield

Manage a team supporting healthcare analytics, develop insights, and support AI and data governance initiatives. | Requires 5+ years in data analytics, healthcare experience, and team management, with skills in SQL, Power BI, and cloud architecture. | Resp & Qualifications PURPOSE: Purpose of the Manager, Data Analytics is to execute business objectives with data and ensure alignment with the vision of the company. Individual will organize the technology, processes and financial resources necessary to address the current and future analytics needs of the business. Provides thought leadership and acts as a subject matter expert in the designing and recommending of appropriate analytical approaches and methodologies. Provides management responsibility into data-driven insights that inform the business's strategic direction. 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. We are not looking for generalists who may have an IT background and various credentials like Scrum, Agile, etc. In this role, the primary responsibility will be to manage a team of 6-7+ individuals supporting the analytics, reporting and data governance activity for work related to Cost of Care Reporting, including Ideation support, Hotspot/Trend Analysis, Dashboard and Report management, Specialty/Member/Provider/Other Detail Reporting and Business Care Support. In addition, we will look to this individual to help support items like AI implementations, partnerships with our IT/Data Management teams, vendor support (ex: Milliman MedInsights) and other related functions. ESSENTIAL FUNCTIONS: • Manage a team of 6-7+ individuals supporting the analytics, reporting and data governance activity for work related to Cost of Care Reporting, including Ideation support, Hotspot/Trend Analysis, Dashboard and Report management, Specialty/Member/Provider/Other Detail Reporting and Business Care Support. Manage a team with a focus on the development of analytics capabilities across the company, including self-service capabilities through technology implementation, best practices and training. Ensure team members serve as a trusted advisor to clients on analytics and data. Support items like AI implementations, partnerships with our IT/Data Management teams, vendor support (ex: Milliman MedInsights) and other related functions. • Interpret statistical analyses and help clients derive meaning from them. • Develop and deliver presentations and reports of analytic findings. • Develop hypotheses and research questions to address clients' needs. Conduct a wide range of quantitative, qualitative, and mixed-methods analyses to answer clients' research questions. • Develop analytic frameworks and select appropriate analytic methods to answer clients' research questions. • Partner with stakeholders to understand data requirements and with internal and/or external resources to develop tools and services such as segmentation, modeling, dashboard development, decision aids, and business case analysis to support the organization. • Uses multiple data sets to create reports and data presentations, and eventually creating data dashboards, for leadership and managerial use. SUPERVISORY RESPONSIBILITY: This position manages people. QUALIFICATIONS: Education Level: Bachelor's Degree in Computer Science, Information Systems or related field OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience. Experience: 5 years Progressive experience relating to data analytics/data analysis. 1 year Supervisory experience or demonstrated progressive experience. Preferred Qualifications: • Master's Degree • Conceptual data and cloud architecture - understands major native data components in Azure and/or AWS and there relationships and use cases. • Mastery of relational database theory include SQL and at least one major RDBMS Well versed in Big Data scenarios and applications. • Experience with multiple analytics delivery tools, methods, and platforms including PowerBI and/or Tableau. • Understanding of Advanced Analytics use cases and the applications of AI/ML for predictive analytics. • Experience not only in these domains. • Experience in building and managing high-performing analytics teams that can deliver work consistently and transparently to our business partners, both internal and external. • Prior healthcare analytics experience is a must. Licenses/Certifications Preferred Upon Hire: Data Management\Certified Analytics Professional (CAP) OR Data Management\MapR Certified Data Analyst. Knowledge, Skills and Abilities (KSAs) • Strong quantitative and qualitative skills. • Knowledge and understanding of analytical tools, such as SAS, Excel, SQL. • Excellent communication skills both written and verbal. • Ability to train others. Salary Range: $126,800 - $235,373 Salary Range Disclaimer The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements). Department Healthcare Analytics Equal Employment Opportunity CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information. Where To Apply Please visit our website to apply: www.carefirst.com/careers Federal Disc/Physical Demand Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs. PHYSICAL DEMANDS: The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted. Sponsorship in US Must be eligible to work in the U.S. without Sponsorship. #LI-NH2

Manage and grow a portfolio of healthcare accounts, develop strategies for retention and growth, and build long-term client relationships. | Requires 8+ years of healthcare sales experience, current health and life licenses for MD, DC, VA, and knowledge of healthcare funding and insurance mechanisms. | 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. Purpose ACTIVE HEALTH AND LIFE LICENSE IS REQUIRED. This position is responsible for renewing/growing a book business which includes more complex 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 account renews annually and aggressively pursues growth within groups by developing and implementing account specific benefit and financial strategies. • Manages and develops a set of assigned accounts to increase productivity and sales of products, as well as identifies potential customers and sets approach strategies. • Develops strong and long-term client relationships. • Takes ownership of territory team initiatives and ensures deadlines are met. • Resolves issues and handles client complaints quickly and effectively. • Gets feedback and suggests ways to increase customer engagement. Supervisory Responsibility Position does not have direct reports but is expected to assist in guiding and mentoring less experienced staff. May lead a team of matrixed resources. Qualifications Education Level: Bachelor's Degree in Business, Finance or related field RO OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience. Experience: 8 years healthcare sales. Preferred Qualifications • Sales experience in the public sector markets with an emphasis on strategic, retention and consultative selling. • Experience in a similar sales position with a competitor or another Blue Cross Blue Shield plan is preferred. Knowledge, Skills And Abilities (KSAs) • Knowledge of underwriting principles; group health/life insurance financial/funding mechanisms; stop loss, medicare advantage, wellness, clinical, managed care and point solutions, healthcare delivery systems, including pricing methodologies and cost reimbursement mechanisms for both self-funded and fully insured business. • Knowledge and understanding of CRM and other client management tools. • Strong customer service orientation. • Ability to recognize, analyze, and solve a variety of problems. • Excellent communication skills both written and verbal. • Must be able to contribute to membership retention and growth as an active participant in our customer-centric, performance-based culture. • Must be able to develop cross-selling strategies to drive specialty product portfolio adoption and member engagement in products while also creating margin growth and additional revenue streams through a diverse product portfolio. • In a consultative fashion, must be able to work with groups, consultants and brokers to better engage membership in CareFirst products and service, delivering on our whole health value proposition. • Must be able to identify and collaborate with internal resources to deliver a differentiated client experience that meets or exceeds their needs and expectations. Licenses/Certifications Current health and life license for the jurisdictions of Maryland, DC, and Virginia Upon Hire Required. Travel Requirements 60% This position is expected to travel to see clients within the CareFirst region. Salary Range: $89,600 - $145,600 (Base Salary Range is based on education, experience & internal equity + Sales Incentive) Salary Range Disclaimer The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements). Department National Accounts DC Equal Employment Opportunity CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information. Where To Apply Please visit our website to apply: www.carefirst.com/careers Federal Disc/Physical Demand Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs. Physical Demands The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted. Sponsorship in US Must be eligible to work in the U.S. without Sponsorship.

Review and adjudicate paper/electronic claims under supervision, ensuring accurate processing and timely payments while collaborating with multiple departments. | High school diploma or GED, less than one year claims processing or billing experience preferred, strong analytical and communication skills, ability to meet deadlines and handle customer service demands. | Resp & Qualifications • *** DMV Remote Position*** PURPOSE: Under direct supervision, reviews and adjudicates paper/electronic claims. Determines proper handling and adjudication of claims following organizational policies and procedures. ESSENTIAL FUNCTIONS: • Examines and resolves non-adjudicated claims to identify key elements of processing requirements based on contracts, policies and procedures. Process product or system-specific claims to ensure timely payments are generated and calculate deductibles and maximums as well as research and resolve pending claims. The Claims Processor also use automated system processes to send pending claims to ensure accurate completion according to medical policy, contracts, policies and procedures allowing timely considerations to be generated using multiple systems. • Completes research of procedures. Applies training materials, correspondence and medical policies to ensure claims are processed accurately. Partners with Quality team for clarity on procedures and/or difficult claims and receives coaching from leadership. Required participation in ongoing developmental training to performing daily functions. • Completes productivity daily data that is used by leadership to compile performance statistics. Reports are used by management to plan for scheduling, quality improvement initiatives, workflow design and financial planning, etc. • Collaborates with multiple departments providing feedback and resolving issues and answering basic processing questions. QUALIFICATIONS: Education Level: High School Diploma or GED. Experience: Less than one year experience processing claim documents. Preferred Qualifications: • Less than one year claims processing, billing, or medical terminology experience. Knowledge, Skills and Abilities (KSAs) • Demonstrated analytical skills. • Demonstrated reading comprehension and ability to follow directions provided. • Basic written/oral communication skills. • Demonstrated ability to navigate computer applications. • Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging. Salary Range: $31,968 - $58,608 Salary Range Disclaimer The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilites of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements). Department Dental Claims Equal Employment Opportunity CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information. Where To Apply Please visit our website to apply: www.carefirst.com/careers Federal Disc/Physical Demand Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs. PHYSICAL DEMANDS: The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted. Sponsorship in US Must be eligible to work in the U.S. without Sponsorship #LI-LY1