Capital Blue Cross

Director of AI and Automation driving business transformation and operational efficiency

Project Manager managing multi-faceted healthcare projects at Capital Blue Cross

Provides support to the Plan by providing resolution of complex clinical complaints, grievances and appeal. Reviews documentation and interprets data obtained from clinical records to apply appropriate clinical criteria and policies in line with regulatory and accreditation requi...

This position is designed to support Sales initiatives that will drive to achieving Sales membership, revenue, or other related business goals. Focus on supporting data analytics and reporting across all lines of business Streamline the use of the customer relationship management...

Duties and Responsibilities: Member-Focus: • Manage telephone, electronic, and face-to-face interactions professionally, efficiently and with excellent communication skills • Effectively present and discuss the products and services to external and internal customers with integri...

The position conducts and participates in activities related to designing, planning, and overseeing initiatives led by the Network Analytics and Pricing (NAP) Department. Analyze data to assist in the design of our Value Based Programs (VBP) - including accountable care arrangeme...

The Provider Service Representatives are the front-line team at Capital BlueCross and are responsible for handling all provider inquiries through multiple channels such as phone, web, provider portal (e.g. Availity), electronic, plan to plan chat, and/or face-to-face. Manage mult...

Base pay is influenced by several factors including a candidate’s qualifications, relevant experience, and anticipated contributions to meet the needs of the business, along with internal pay equity and external market driven rates. The salary range displayed has not been adjuste...

The Clinical Special Investigator is responsible for identifying and investigating suspected cases of claim and program fraud waste or abuse. Proactive review of claims reports and anti-fraud software reports to identify and initiate investigations Apply clinical standards, medic...

RN Care Manager coordinating member care at Capital Blue Cross