Capital Blue Cross

Manager

• Coordinate services for members who meet established criteria
• Educate members and promote self-management, quality care, and cost-effective outcomes
• Assess member needs and review service and resource options
• Develop and implement individualized plans of care
• Coordinate resources and monitor member progress
• Evaluate member status and discharge members when criteria are met
• Document the individualized member care management process and outcomes
• Address medical, psychosocial, clinical, behavioral health, mental health, and substance use disorder needs
• Provide counseling and referrals to community, local, and state programs
• Collaborate with caregivers, providers, community agencies, behavioral health teams, and other resources
• Manage and oversee a caseload of moderate- to high-risk members with complex needs
• Serve as a liaison among participants, families, physicians, and treatment-team members
• Analyze and evaluate referrals for potential program enrollment
• Conduct assessments to determine acuity, functional status, psychosocial status, and barriers
• Obtain required consent forms
• Apply discharge criteria and discharge members from care management programs
• Identify and report quality-of-care issues
• Maintain member confidentiality
• Attend company and departmental meetings and training sessions

RN Care Manager

Support Engineer

• Research and review customer inquiries related to vendor lines of business
• Interpret applicable policies and procedures and determine appropriate actions
• Obtain benefits, enrollment, and claims information using PCs, manuals, online references, Imaging, and other systems
• Resolve routine and complex inquiries involving benefits, claims, billing, enrollment, legal requests, Medicare Secondary Payer, COBRA, reinstatements, conversions, refunds, and related issues
• Conduct job-related instructional sessions as requested
• Respond to customers via telephone, correspondence, on-site interactions, fax, Secure IT, email, and personal interviews
• Monitor vendor inquiries through system-generated reports for timely and accurate resolution
• Provide instructions to appropriate plan areas for issue resolution
• Contact internal and external entities to obtain information and initiate action
• Update Facets inquiries, Sales Force cases, and Work Desk records and maintain progress notes
• Report trends and processing problems to management
• Support Marketing personnel and brokers by researching and communicating customer information
• Participate in marketing activities such as open enrollment and on-site visits
• Complete ongoing training and learn new skills
• Recognize, document, and report customer-service trends to the supervisor
• Maintain conduct consistent with organizational values

Client Services Pharmacy Support Analyst

Platform Engineer

• Administer and support the enterprise Power BI and Microsoft Fabric environment, including security, workspaces, capacities, gateways, deployment processes, monitoring, and platform configurations
• Establish and maintain governance standards, development practices, lifecycle controls, security requirements, and operational procedures
• Ensure platform availability, reliability, performance, scalability, and compliance with enterprise policies and regulatory requirements
• Monitor platform health, troubleshoot complex issues, implement performance improvements, and support capacity planning and optimization
• Maintain platform documentation, support procedures, and operational controls
• Design, develop, administer, and optimize reusable semantic models, datasets, dataflows, and governed analytics assets
• Establish standards for shared business definitions, measures, calculations, and reporting logic
• Design, develop, and maintain dashboards, reports, scorecards, and analytical solutions using Power BI, Fabric, and related Microsoft technologies
• Develop and optimize DAX calculations, data transformations, visualizations, and reporting logic
• Create reusable templates, themes, and development standards
• Support modernization, consolidation, and lifecycle management of enterprise reporting solutions
• Establish operational standards, service metrics, and usage reporting for platform governance, adoption, and optimization
• Troubleshoot and resolve complex platform issues, perform root-cause analysis, and implement corrective actions
• Optimize platform configurations, semantic models, reports, refresh processes, and capacity utilization
• Partner with business stakeholders, analysts, developers, and technology teams to deliver scalable analytics solutions
• Provide technical consultation, guidance, training, and support for platform capabilities, analytics architecture, semantic models, security, and reporting solutions
• Promote responsible adoption of Power BI, Fabric, and self-service analytics through standards, education, and community engagement
• Support production analytics environments and communicate platform changes, issues, and new capabilities
• Evaluate, prototype, and recommend Power BI, Microsoft Fabric, automation, Copilot, and AI-enabled analytics capabilities
• Support the enterprise analytics platform roadmap and modernization initiatives
• Participate in architecture discussions involving analytics, reporting, and enterprise data platforms
• Develop and support governed AI-powered analytics solutions, trusted data assets, and reusable analytics capabilities

Senior Analytics Platform Engineer

Data Engineer

• Manage assignment, workflow, and oversight processes to ensure quality, consistency, and timeliness of data engineering deliverables
• Create and maintain standards for data design, modeling, and deployment in Snowflake
• Provide direction and training 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 schedules
• Provide guidance to data analysts on best practices for leveraging and querying new data assets
• Interpret business needs and rapidly implement effective technical solutions supporting consistent enterprise data delivery
• Create and maintain ETL source-to-target mapping documents, data playbooks, and data flow inventory documents
• Provide technical guidance and best practices for design, modeling, and data presentation/implementation
• Ensure the team’s skillsets support future success

Manager, Data Engineering

Business Operations

• Organize and coordinate team events and related logistics
• Coordinate responses to internal and external requests for information
• Gather input from team members, track deadlines, consolidate responses, and ensure timely completion
• Collect, organize, validate, and compile data from multiple sources
• Support reporting, business reviews, operational tracking, and leadership decision-making
• Prepare presentations, meeting materials, summaries, and other documents
• Format content, incorporate data and team input, proofread, and ensure materials are accurate and professionally presented
• Perform general administrative tasks including processing invoices, completing security access requests, maintaining files, tracking assignments, and supporting routine operational needs
• Work independently and collaboratively across the organization to track priorities, gather input, meet deadlines, and provide accurate, timely, and professional day-to-day operational support

Business Operations Coordinator

General

• Deliver health coaching, health education services, and multi-session programs
• Support individualized coaching on healthy eating, weight management, goal setting, and wellness topics
• Deliver health education through exhibits, presentations, and engagement opportunities
• Perform biometric screenings using Cholestech analyzers and body composition assessment devices
• Develop and prepare outreach and marketing materials
• Collaborate with internal departments to promote wellness services
• Refer members to appropriate programs, services, tools, and resources
• Review programs and educational materials for accuracy, clarity, and appropriateness
• Provide feedback on program effectiveness and suggest process improvements
• Manage data and compile reports on wellness programs and activities
• Document activities in designated databases and systems
• Prepare and deliver activity reports to Health Promotion and Wellness leadership
• Monitor program outcomes and data quality
• Order and maintain supplies for health coaching, screening, and wellness services
• Ensure compliance with PA DOH lab licensure and CLIA waiver requirements
• Assist with peer orientation and ongoing development
• Participate in departmental, cross-functional, and organizational meetings
• Work onsite at the Capital Blue Cross Connect Center, travel to community events, and occasionally work remotely

Health Promotion & Wellness Specialist

• Build, refactor, and maintain pipeline components of cloud-based data products
• Own ingestion, storage, cleansing, profiling, transformation, and presentation of data products
• Analyze large and complex datasets for quality, accuracy, anomalies, and performance
• Own pre-UAT testing for every change using the standard ABC framework
• Consult with analysts and stakeholders on data requests, enhancements, recommendations, quality, and awareness
• Assess integration restrictions and options, and recommend load strategy, storage targets, data access layer model, and solution architecture
• Participate in modeling star-schema data marts, denormalized performant layers, presentation layers, and Data Vault or other immutable storage
• Organize source code using a versioning framework
• Create and maintain reference architecture diagrams and engineering documentation
• Triage emergent data concerns and coordinate with stakeholders through resolution

Consultant

• Lead all components of the vendor lifecycle for Tier 1 and Tier 2 vendors, including vendor strategy and prioritization, negotiation strategy development and execution, cross-functional business engagement, vendor oversight and performance management, and value realization tracking
• Participate as a strategic contributor in RFP, RFI, and RFQ sourcing events
• Define sourcing requirements, evaluate vendor responses, and support negotiation strategy and final vendor selection decisions
• Improve strategic vendor management practices, including vendor prioritization, negotiation effectiveness, benchmarking utilization, and stakeholder engagement
• Draft, negotiate, obtain approval for, and execute vendor contracts
• Monitor vendors’ performance against contracts, including performance guarantees and service levels
• Communicate regularly with internal business stakeholders regarding vendor performance
• Participate in decisions to disengage or renew vendors and assist with disengagement or renewal
• Identify and implement process improvements to increase overall vendor lifecycle effectiveness
• Work with Privacy, Security, Legal, and Compliance to ensure the Vendor Lifecycle follows relevant policies, procedures, laws, and regulations
• Represent Vendor Alliances in internal work groups and Department/Division strategy meetings
• Advise business groups on processes and strategies that align, or do not align, with vendor contract terms and conditions
• Assist in developing and modifying Capital's vendor strategy, including sourcing, negotiation, oversight, and disengagement
• Serve as an internal consultant to business areas on vendor strategy and engagement

Vendor Alliances Consultant

• Provide day-to-day leadership, direction, and prioritization to Vendor Alliances Consultants
• Lead, develop, and mentor members of the Vendor Alliances Consulting team
• Enable strategic execution across high-risk, high-priority vendor portfolios
• Establish priorities aligned to vendor tiering, complexity, and strategic importance
• Coach Consultants on negotiation strategy, stakeholder engagement, and value realization
• Drive consistency in strategic vendor management practices, including benchmarking, business case development, and executive engagement
• Strategize with internal business stakeholders to determine vendor needs and alignment with corporate goals
• Participate in vendor contracting, including drafting, redlining, and negotiating
• Maintain a portfolio of especially complex, high-risk, high-priority vendor relationships as needed
• Facilitate the review and execution of highly confidential agreements
• Identify and implement process improvements across the vendor lifecycle
• Support VA sourcing activities as a strategic participant
• Serve as a backup to Vendor Alliances Consultants as needed
• Lead departmental projects as needed
• Lead change management initiatives within the Vendor Alliances department and cross-functionally
• Advance strategic vendor management, negotiation, value realization, governance, risk management, cost optimization, and best practices

Vendor Alliances Lead

Financial Planning and Analysis

• Oversee processing of invoices, vendor payments, ACH transactions, wires, checks, and expense reimbursements
• Manage exception resolution, approval workflows, vendor inquiries, and payment-related escalations
• Lead month-end activities, including accrual support, account reconciliations, and financial reporting requirements
• Administer purchasing operations, including purchase requisitions, purchase orders, vendor onboarding, and vendor maintenance
• Ensure compliance with procurement policies, approval authorities, contracting requirements, and internal controls
• Monitor purchasing and spending activity, identify trends and risks, and support cost management and efficiency initiatives
• Administer corporate travel, expense reimbursement, and corporate card programs
• Review and resolve expense report exceptions, disputed transactions, policy violations, and other operational issues
• Maintain internal controls and audit readiness over disbursement, purchasing, travel, and expense processes
• Support internal, external, and regulatory audits through documentation, testing, and process compliance activities
• Develop, maintain, and communicate policies, procedures, training materials, and operational standards
• Serve as functional business lead for Workday Financials, Procurement, and Expense modules
• Partner with Finance, HR, and IT to optimize processes and reporting
• Develop and monitor operational metrics, dashboards, and key performance indicators
• Lead continuous improvement initiatives
• Supervise, coach, and develop staff; establish performance expectations; support cross-training and succession planning

Finance Operations Supervisor

Member Service Representative

• Provide efficient, courteous, professional service to members, providers, group administrators, brokers, Plan personnel, and the general public
• Respond to inquiries received by telephone, fax, written correspondence, email, internet messenger, and personal interviews
• Address enrollment, billing, benefits, and claims inquiries for various coverage types
• Research and analyze customer inquiries using policies, procedures, PC systems, manuals, and Image
• Resolve routine and moderately complex benefits, claims, billing, enrollment, COBRA, Medicare Secondary Payor, and related issues
• Provide clear instructions to appropriate Plan areas for issue resolution
• Contact internal and external entities to obtain information and initiate necessary action
• Respond verbally or in writing with accurate and timely information
• Monitor inquiries for timely and accurate resolution and customer satisfaction
• Update Facets or Inquiry Control System records to track inquiry actions and status
• Report inquiry trends to management
• Support Marketing personnel and brokers by researching and communicating customer information
• Participate in marketing activities such as health fairs, seminars, open enrollment, and on-site visits

Technical Recruiter

• Develop and implement innovative recruitment strategies to proactively source highly qualified applicants
• Recruit, interview, evaluate, and recommend qualified applicants for individual contributor and leadership roles
• Conduct screening interviews and present qualified candidates to management
• Collaborate with business partners to understand talent needs and recommend effective solutions
• Participate in community and college/university events to promote internship and full-time opportunities
• Partner with external recruiting agencies for specialized and hard-to-fill positions
• Facilitate intake discussions between hiring managers and agency partners
• Negotiate contingent labor bill rates and manage vendor relationships
• Oversee contingent workforce onboarding coordination, documentation, compliance requirements, and system transactions
• Support Capital's IT&D division by developing and executing sourcing and recruiting strategies for technical talent
• Maintain understanding of emerging technologies, technical skill sets, and labor market trends
• Assess technical backgrounds and evaluate candidate qualifications against business needs
• Apply due diligence practices to identify inconsistencies, misrepresentations, or concerns related to candidate credentials, experience, or identity
• Serve as a trusted advisor to hiring leaders with market insights, talent intelligence, and recruiting strategy guidance
• Provide recruitment support for other Capital business areas as required