CareFirst Careers

Health Insurance Claims Director

Resp & Qualifications


The Director of Health Insurance Claims will be responsible for the Medical Claims, Service, Enrollment, Billing and Account Installation departments to ensure that operations run with optimum efficiency to achieve all internal and external corporate goals and objectives. 

Responsible for the delivery of the highest levels of member, account and provider satisfaction and/or that claims and inquiries are handled in a consistent, timely, cost effective and high-quality manner, while providing support to all internal areas as needed.  Ensures attainment of goals by developing, approving and implementing operational strategies, plans and objectives, monitoring and ensuring the efficiency and effectiveness of the operation, evaluating workflows, procedures, policies and staffing needs, and always adhering to external, corporate and customer/provider standards for quality, timeliness and accuracy.  Responsible for the development and implementation of strategies and tactics to ensure continued improvement in the synchronization of systems, people and processes.


Under the general supervision of the Vice President of Claims, the Director’s accountabilities include, but are not limited to, the following:

1. Directs the activities of the Claims, department by reviewing and analyzing medical claims inventories, timeliness, accuracy, productivity, cost, appeals, and complaint reports, or equivalent customer service data, to strategically determine the allocation of staff, training needs, and improve current processes to consistently exceed all performance expectations.  Responsible for identifying and resolving corporate issues involving respective departments.

2. Responsible for planning and monitoring departmental activities and needs, collection and analysis of performance data, and performance management of Managers and other staff reporting to this position.  Responsible for meeting staffing needs, associate development, and performance assessment of all direct and indirect reports.

3. Participates in Operations projects and meetings in order to achieve and maintain optimum efficiency and satisfaction standards.


Direct reports include but are not limited to: Health Insurance Claims Operations Managers and non-management staff such as Administrative Assistants, Project Managers, and Operations Trainers.  Provides oversight of up to approximately 100 indirect reports and 5 direct reports.



  • Bachelor’s Degree in Business Administration, Healthcare Administration or related discipline or equivalent experience
  • 8-10 years of progressively responsible managerial functions in a Medical Claims, Customer Service, Enrollment or Billing related discipline.
  • Health Insurance Medical Claims and Call Center Experience is essential; including knowledge of state-of-the-art technology. 


Abilities/Skills:  The individual must have extremely strong analytical and problem-solving skills, and the ability to develop and implement policies and programs that will advance corporate and operational goals and objectives.  Excellent planning, problem solving, negotiation, presentation, written and oral communication skills are required.  Excellent interpersonal skills, the ability to effectively manage a staff through leadership and the promotion of teamwork is essential.  The incumbent must possess excellent interpersonal skills and highly developed written and oral communication skills to effectively convey complex and detailed concepts to a diverse audience.  The incumbent must possess extremely well developed organizational and prioritization skills.

Must be able to effectively work in a fast paced environment with frequently changing priorities, deadlines, and  workloads that can be variable  for long periods of time.  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.


  • Master’s degree preferred
  • Prior experience in a Health Insurance Medical Claims environment is strongly desired




Department: Commercial, Individual, Small Group Business  Unit MD Local Commercial Ad

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.

Hire Range Disclaimer

Actual salary will be based on relevant job experience and work history.

Where To Apply

Please visit our website to apply:

Closing Date

Please apply before: 10/25/2019

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.


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

Featured Job


Learn more about Customer Service & Claims