Remote Jobs at Capital Blue Cross
Find your next remote opportunity · 27 Open Positions
At Capital Blue Cross, we promise to go the extra mile for our team and our community.
This promise is at the heart of our culture, and it’s why our employees consistently vote us one of the “Best Places to Work in PA.” We recognize that work is a part of life, not separate from it, and foster a flexible environment where your health and well-being are prioritized.
At Capital you will work alongside a diverse and caring team of supportive colleagues and be encouraged to volunteer in your community.
We value your professional and personal growth by investing heavily in training and continuing education, so you have the tools to do your best as you develop your career.
And by doing your best, you’ll help us live our mission of improving the health and well-being of our members and the communities in which they live.
To increase employee engagement and provide opportunities for networking, learning, career development, and community outreach, Capital also has several Employee Resource Groups.
Our goal is to involve all employees in helping us to create a culture of acceptance, understanding, and growth.
Capital Blue Cross is an independent licensee of the Blue Cross Blue Shield Association serving 21 counties in Central Pennsylvania and the Lehigh Valley.
Provider Audit Specialist
Provider Audit Specialist responsible for auditing hospital charge data and claims. Collaborating with internal teams to ensure billing compliance and recommend improvements.
Senior Business Systems Analyst
Senior Business Systems Analyst providing analytical and technical support for Capital Blue Cross core systems. Collaborating with teams and ensuring innovative solutions for business problems.
Manager, Government Enrollment & Appeals
Manager overseeing enrollment and billing operations across Medicare Advantage and related programs at Capital Blue Cross. Leading compliance efforts and managing appeals and grievances for government programs.
HEDIS Performance Analytics Lead
Senior Analyst powering HEDIS improvement initiatives through advanced data analytics and insight generation. Leading development of predictive models and translating findings into actionable recommendations.
Clinical Vendor Consultant
Clinical Vendor Consultant coordinating clinical services and vendor projects for Capital Blue Cross. Collaborating with departments to improve healthcare quality and manage vendor relationships.
Information Security Specialist
Information Security Specialist at Capital Blue Cross monitoring and responding to cyber threats. Collaborating with IT teams to enhance security posture and compliance with industry standards.
Senior Provider Audit Specialist
Lead complex, high-impact audits of hospital billing and reimbursement practices at Capital Blue Cross. Drive financial integrity and compliance across the organization by developing audit strategies and mentoring team members.
Medical Value Systems Data Analyst II
Data Analyst II at Capital Blue Cross focusing on Value Based Programs and analytics. Analyzing data to support healthcare strategies and collaborating with internal teams to drive initiatives.
RN Clinical Quality and Oversight Consultant
RN Clinical Quality and Oversight Consultant ensuring compliance with federal and state regulations. Planning and executing quality oversight activities for Capital Blue Cross.
Payment Integrity Claims Editing Analyst
Analyst providing analytical, technical, and problem resolution support to Payment Integrity Claims Editing System. Working with internal partners to ensure adherence to standards and regulations.
Population Health Clinical Consultant, Registered Nurse
Population Health Clinical Consultant Registered Nurse at Capital Blue Cross implementing health strategies. Collaborating with teams to enhance member care and health outcomes through data-driven initiatives.
Medicare Stars & Quality Program Analyst
Analyst supporting Capital Medicare Advantage Star Ratings Program analytics. Focused on improving or maintaining Medicare stars ratings through data-driven strategies and reporting.
Senior Government Operations Analyst
Senior Operations Business Analyst providing support across Claims, Customer Service, Enrollment & Billing, and Appeals & Grievances. Focusing on Medicare Advantage appeals and claims processing workflows.
Senior Government Ops Business Consultant
Senior Operations Consultant providing analytical support to business areas and customers at Capital Blue Cross. Acts as a subject matter expert and mentors business consultants and analysts.
Actuary
Actuary analyzing and establishing insurance rates and statistical data at Capital Blue Cross. Collaborating on financial projections and mentoring lower level employees while enhancing actuarial principles.
Provider Contract Manager
Provider Contract Manager responsible for negotiating contracts with healthcare providers. Leading strategic initiatives to enhance provider relationships and drive value-based programs.
Director, Enterprise Architecture
Director Enterprise Architecture responsible for developing and implementing Capital's Enterprise Architecture strategy. Leading technology initiatives and ensuring alignment with corporate objectives.
Clinical Quality and Oversight Consultant
Quality and Oversight Consultant planning and executing audits for compliance. Responsible for educating staff and monitoring quality activities within Capital Blue Cross.
RN Care Manager – Oncology
Care Manager coordinating member services for optimal health outcomes in a remote setting. Emphasizing education/self-management and promoting quality care with a focus on behavioral health needs.
Healthcare Data Analyst – Risk Adjustment, Medicare
Healthcare Data Analyst supporting risk adjustment program analytics assisting in strategy execution at Capital Blue Cross. Collaborating on reporting and operational effectiveness in a remote environment.