Remote Jobs at Capital Blue Cross
Find your next remote opportunity · 20 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.
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 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.
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.
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.
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.
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.
Government Programs Risk Adjustment Coder
Risk Adjustment Coder conducting compliance reviews and audits to ensure Medicare Advantage accuracy. Collaborating with healthcare providers and maintaining coding standards per CMS guidelines.
Network Contract Analyst
Network Contract Analyst performing contract administration and analytic work for Capital Blue Cross. Collaborating with teams on provider contracts and reimbursement strategies in a healthcare environment.
Manager, Pharmacy Stars and Member Outreach
Manager leading Pharmacy Member Outreach team and overseeing operations for Medicare Pharmacy team at Capital Blue Cross. Ensures performance standards and process improvements in pharmacy services for members.
Medical Value Analyst II
Medical Value Analyst II analyzing data to assist in design of value based programs at Capital Blue Cross. Collaborating with analysts and resolving operational issues in health care analytics.
Performance Analyst
Performance Analyst responsible for FEP Plan performance audits and data validation. Analyzing claims and customer service inquiries; supporting audit processes within a healthcare organization.
Senior Healthcare Data Analyst – Risk Adjustment, Medicare & ACA
Senior Healthcare Data Analyst managing risk revenue initiatives for Medicare and ACA programs. Analyzing large datasets to improve quality of care and optimize revenue.
Senior Health Education Consultant
Senior Health Education Consultant managing wellness education and vendor programs at Capital Blue Cross. Responsible for project management, data analysis, and developing wellness initiatives.
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