10 analyst risk operations jobs found in Baltimore

CareFirst BlueCross BlueShield Resp & Qualifications We are looking for an experienced professional in the greater Baltimore/Washington metropolitan area who is willing and able to work in a hybrid model. The incumbent will be expected to work a portion of their week from home and a portion of their week at a CareFirst location based on business needs and work activities/deliverables that week. PURPOSE: The main purpose of a data analyst is to find meaning in data as a thought leader so that the derived knowledge can be used to make informed decisions and assist the organization in making better business decisions. ESSENTIAL FUNCTIONS: Engages in data exploration using various programming languages (reading and writing code), requiring advanced knowledge of multiple database structures Collect, analyze, and interpret data to glean insights, and develop business appropriate recommendations Serve as an expert resource supporting data questions and issues from...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: Acts as an internal expert to ensure that as value-based reimbursement and medical policy models are developed and implemented. Provides expert knowledge to support effective partnership with provider entities and guidance on the appropriate quality measure capture and proper use of CPT and ICD 10 codes in claims submissions. Utilizes coding expertise, combined with medical policy, credentialing, and contracting rules knowledge to build the effective guides and resources for providers on the expected methodologies for billing and code submissions to maximize quality and STARs outcomes while not compromising payment integrity. Provides expertise and mentoring to other team members. We are looking for an experienced professional in the greater Baltimore/Washington metropolitan area who is willing and able to work in a hybrid model. The incumbent will be expected to work a portion of their week from home and...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: The Business Consultant ACA Individual provides strategic, analytical, and operational expertise to support the design, launch, and execution of initiatives that strengthen ACA Individual market performance. This role contributes directly to CareFirsts ACA growth strategy by delivering insights, driving operational efficiencies, and supporting cross-functional alignment in a rapidly evolving healthcare environment. ESSENTIAL FUNCTIONS: Support the development of ACA dashboards in partnership with the external analytics vendor to segment member populations, identify cost-saving opportunities, and drive performance improvement. Leverage analytics to inform ACA marketing strategies by identifying priority populations and geographic segments. Collaborate with risk adjustment, care management, quality, and network teams to i improve coding performance and overall ACA member outcomes. Conduct competitive...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: a { text-decoration: none; color: #464feb;}tr th, tr td { border: 1px solid #e6e6e6;}tr th { background-color: #f5f5f5;} This role supports the Dual Special Needs Population (DSNP) in Maryland. Under minimal supervision, the Care Manager conducts thorough research and analysis of members medical and behavioral health needs, along with the key drivers influencing healthcare utilization and costs. The Care Manager partners closely with members and the interdisciplinary care team to develop and implement person-centered plans of care that promote a positive member experience, improved health outcomes, and costeffective service delivery. We are seeking a bilingual Care Manager to enhance communication, cultural responsiveness, and engagement with our diverse DSNP member population. This position is remote, with the expectation that the selected candidate resides within the greater Baltimore metropolitan area....

CareFirst BlueCross BlueShield Resp & Qualifications CareFirst runs a year-round internship program. The ideal candidate is someone who can work throughout the year 15-20 hours per week. PURPOSE: The organizational function of an Enterprise Architecture (EA) team is to ensure that business strategy, operating model, capabilities, information, and technology investments are intentionally aligned so the enterprise delivers value faster, with less redundancy, lower risk, and clearer accountability. Interns assist the company with tasks set out by various teams, such as research, data capturing, and working closely with different team members to learn more about the company. As an intern for the Enterprise Architecture team, the individual will play a key role in helping us design and launch procedures that will help maintain this reliability and consistency of enterprise portfolio data. This internship will also assist with procedural mechanics of Enterprise...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: The Senior FP&A Analyst supports CareFirsts enterprise cost management and transformation agenda by combining strong FP&A fundamentals with driver based budgeting (DBB), business case development, and performance tracking. This role partners with Finance and business leaders to improve forecasting accuracy, enhance cost transparency, and ensure initiatives deliver measurable financial impact. The analyst also leverages BI skills to help FP&A produce more scalable and insight driven reporting. ESSENTIAL FUNCTIONS: Produce and update cost forecasts and annual plan inputs using driver based models and scenario analysis. Deliver monthly and quarterly variance analysis with clear explanations of drivers, risks, and recommended actions. Translate operational drivers (headcount, vendor spend, utilization) into financial impacts supporting G&A decision making. Partner with business...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: Performs complex analysis, design, development, automated unit and integration testing, and debugging of computer software ranging from operating system architecture integration and software design to selection of computer systems, language, and/or equipment. Designs, codes, tests, develops, and documents application programs for computer systems. Works with end-users and project stakeholders to define system scope and objectives. Manages modifications to and maintenance of operational programs and procedures. Leads stakeholder and product owner meetings to define software requirements and creates highly complex systems. Acts as a mentor to junior engineers. ESSENTIAL FUNCTIONS: Lead a team of software engineers in the design, development, and implementation of multiple applications. Performs and leads the detail technical design, coding, code review and testing of new applications and enhancements of...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE The Senior Analyst, FP&A Workforce Planning & Operations Analytics develops longrange operational forecasts, workforce capacity models, and analytical tools that guide staffing, budgeting, and servicelevel decisions. The role combines financial planning, data analytics, and workforce modeling to deliver clear insights that optimize staffing and labor costs. This position is ideal for a datasavvy analyst looking to deepen FP&A and operational strategy experience while applying advanced technical skills (SQL, Excel, Python, Power BI, MS Fabric/Azure) ESSENTIAL FUNCTIONS: Forecasting & Demand Modeling: Develop driver-based demand forecasts using enrollment, product changes, seasonality, regulatory shifts, digital adoption, and other operational trends/drivers. Translate business growth (membership, product launches, group movement) into actionable operational workload across all teams in...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: This role manages the appeal process for members and providers who appeal on behalf of members for Commercial lines of business. Ensures quality management of the clinical appeal process to reduce the risk of State and Federal Regulatory fines and sanctions, avoid adverse exposure, reiterate the expectation of a fair and compliant appeal process for our membership, and support NCQA accreditation and the Divisional Goals for Care Management. We are looking for an experienced clinical leader in the greater Baltimore metropolitan area who is willing and able to work in a hybrid model. The incumbent will be expected to work a portion of their week from home and a portion of their week at a CareFirst location based on business needs and work activities/deliverables that week. ESSENTIAL FUNCTIONS: Develops, establishes and implements a compliant appeal process with dynamic goals resulting in the full and...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: Acts as an internal expert to ensure that as value-based reimbursement and medical policy models are developed and implemented. Provides advanced knowledge to support effective partnership with provider entities and guidance on the appropriate quality measure capture and proper use of CPT and ICD 10 codes in claims submissions. Utilizes extensive coding knowledge, combined with medical policy, credentialing, and contracting rules knowledge to help build the effective guides and resources for providers on the expected methodologies for billing and code submissions to maximize quality for FWA prevention. ESSENTIAL FUNCTIONS: Consults on proper coding rules in value-based contracts to ensure appropriate quality measure capture and proper use of CPT and ICD10 codes. Provides input on various consequences for different financial and incentive models. Supports to use of alternatives and solutions to...