70 education jobs found in Baltimore

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: Join our team to lead the creation of CareFirsts next-generation Integration Platform, seamlessly blending API-first design with a product-based approach to advance our cloud-native strategy. Play a pivotal role in transforming how we operate, enabling faster innovation, streamlined execution, and cost-effective solutions that scale across our Enterprise Portfolio. CareFirst is undertaking a digital transformation which requires enterprise agility paired with the retooling of our technology stack to speed-up delivery and to expand our reach. The Digital Factory organization is leading this charge by advancing our Scaled Agile Framework (SAFe) ways of working across the organization. To drive this transformation, the Platform Engineering Manager is a key role within the Integration & Interoperability team that builds technical depth, expertise, and resource management within the Nexus platform....

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: Manages end-to-end oversight of the Stored Information Retrieval (SIR) system and related operational processes including front-end mail room services, document scanning and digital record storage related to member and provider submitted paper claims, correspondence, appeals, finance checks, enrollment forms and provider credentialing forms. Drives teams and internal projects to maintain and enhance program performance over time. Guides stakeholders through key decisions, communicates and coordinates activities internally and across departments. Facilitates process improvement and identifies and articulates stakeholder needs to drive strategies and maximize outcomes related to ROI, customer satisfaction, and organizational metrics and performance. Takes full ownership of all components of program from day to day tasks to building road maps, driving strategy and leading organization wide initiatives...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: Performs advanced actuarial and oversight skills in the performance of actuarial analytics to develop actionable items in support of departmental goals Provides actuarial leadership support to Medical, Pricing, Underwriting, Sales, Finance and other applicable Business Units. Responsible for actuarial modeling to support financial objectives. and making recommendations to executives and senior management. ESSENTIAL FUNCTIONS: Responsible for directing the efforts of Actuarial staff (Pricing, Actuarial Finance, Actuarial Medicare Advantage, Actuarial Innovation and Research) to accomplish near and long-term goals set by senior management. In collaboration with senior management, responsible for setting long term strategy within the Actuarial department. Responsible for representing the Actuarial department to internal and external customers including state and federal regulators. Hiring, recruiting...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: Executes medium to complex sourcing projects, from start to finish. This role will rationalize the supply base through strategic sourcing, lead cross-functional team to achieve optimal total cost of ownership, identify cost savings opportunities across the company, support overall supply requirements and ensure an effective spend analysis for assigned category. ESSENTIAL FUNCTIONS: Provides sourcing services (RFx, reverse auctions, negotiations) to clients based on predefined service levels, managing 5-12 simple to complex projects simultaneously with limited supervision/guidance or independently. Executes sourcing strategy by leading formal sourcing processes including stakeholder engagement, RFP processes and contract negotiations. Assists in the development of category sourcing strategy leading cross-functional teams to execute the sourcing strategy. Partners with customer groups to establish...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: The Appeals Specialist I is responsible for the initial analysis of appeals and/or grievance correspondence, and determination of next steps for Commercial and FEP lines of business. Responsible for collecting, organizing and tracking information to facilitate and expedite processing of appeals and/or grievances received from a variety of sources. We are looking for an experienced professional to work remotely from within the greater Baltimore metropolitan area. The incumbent will be expected to come into a CareFirst location periodically for meetings, training and/or other business-related activities. ESSENTIAL FUNCTIONS: Prioritize, research and analyze all pertinent information in preparation of an appeal and/or grievance request. Access the appropriate database to implement accurate and timely entry of appeal, grievance and/or reconsideration correspondence and updates the appropriate referral...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: The Broker Relations Manager's primary responsibility is to bring the value of CareFirst to the marketplace by engaging and working with CareFirst's distribution channel (brokers). This role combines strategic leadership with hands-on management to ensure brokers receive timely, accurate, and comprehensive assistance. The ideal candidate will foster a customer-centric culture while driving operational excellence and team development. ESSENTIAL FUNCTIONS: Broker Relationship Management Serve as the primary escalation point for complex broker inquiries and issues, ensuring timely and satisfactory resolution. Build and maintain strong relationships with key broker partners, full service producers and consultants, understanding their needs and business objectives. Monitor broker satisfaction metrics and implement strategies to improve service delivery and partner experience. Collaborate with sales...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: This position maty be responsible for preparing analyses associated with the development of reimbursement policy, strategies, cost of care impacts and work flows for healthcare providers' reimbursement fee levels. The incumbent will work with various commercial and government program related fee schedules, develop recommendations and prepare competitive analyses to include industry, regional, and internal benchmarks. Will be responsible for reviewing and analyzing information for various provider reimbursement and network strategy projects, preparing routine reports and fee disclosure related documents. Knowledge of Medicare or Medicare Advantage products preferred. We are looking for an experienced professional to live and work remotely from within the greater Baltimore/Washington metropolitan area. The incumbent will be expected to come into a CareFirst location periodically for meetings, training and/or...

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: This role will lead, guide, strategize and manage negotiations for provider-specific institutional, ancillary, and professional contracts. Key responsibilities include negotiating contract terms in accordance with regulatory requirements, analyzing financial data to evaluate implications across various business lines, while ensuring compliance with company policies and procedures, and coordinating with the Payment Transformation team to transition fee-for-service arrangements to value-based care. This role will also oversee complex projects related to provider...

CareFirst BlueCross BlueShield Resp & Qualifications CANDIDATES MUST LIVE IN THE MD, DC, NORTHEN VA AREA IN ORDER TO TRAVEL INTO THE OFFICES AND FOR CLIENT MEETINGS AND STAFF MEETINGS. PURPOSE Manages and supports the sales growth and retention of assigned Account Consultants for Mid-Market (51-99) market segments. Conducts sales and service to assigned accounts. Monitors the development and implementation of strategic long-term customer relationships. Achieves targeted Retention Sales goals for the unit. ESSENTIAL FUNCTIONS Develops account strategies in accordance with overall strategy. Works with the team and Brokers to maximize retention and growth. Manages the Renewal support/service functions essential to day-to-day account, service, productivity, implementation and retention. Develops account goals and business plan with customer. Conducts regular reviews of business performance, promotion strategies, and planograms. Forecasts, budgets, and tracks...

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 This role is a Hybrid position with 10-24 days per quarter in our Baltimore City, Columbia, MD or Washington DC office. PURPOSE: The Employee Relations Specialist partners with employees, managers and Human Resources Business Partners to investigate and bring resolution to employee relations issues that provide fair and consistent treatment to all employees, and in a manner consistent with the company's policies, procedures, and state and federal law. ESSENTIAL FUNCTIONS: Conducts basic/moderately complex HR investigations, including intake processes, investigation planning and interviews, recommendation and determination, and reporting/insights analysis. Communicates and updates status of investigations to relevant managers and HRBPs. Collects and maintains evidence, including testimonial and documentary evidence, for use in drawing investigative conclusions. Draft summary reports detailing findings resulting...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: Provides leadership that drives strategic vision of the Company's financial systems, including the ERP and EPM systems and the suite of applications that connect to those. This role will work with the Finance and IT leadership teams and other business partners to develop and continually maintain an innovative future-state roadmap for financial systems and processes taking into account business priorities and strategic objectives. This role will collaborate with the leadership teams across the organization on applications strategy and in building out key capabilities and services to support the organization. Responsible for driving innovation in a fast-paced rapid growth environment, delivering software solutions that meet or exceed customer and stakeholder expectations in a manner that optimally leverages technology. ESSENTIAL FUNCTIONS: Responsibility for support and maintenance of our Finance...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: The Specialist, Account Installation II is responsible for the installation of more complex assigned accounts into core platforms and complimentary systems, including, but not limited to: development of the account structure and billing set up to align with documented account requirements, coordination of structure revisions, researching and resolving setup and structure issues, database management, and management of related administrative documents. Provide new hire support through training and pre-auditing as well as cross-training existing associates. ESSENTIAL FUNCTIONS: Perform installation of more complex assigned accounts, including, but not limited to: development of the account structure and billing set up to align with documented account requirements, coordination of structure revisions, researching and resolving setup and structure issues, database management, and management of related...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: The Risk Adjustment Coding Specialist supports the retrospective risk adjustment supplemental filing, Risk Adjustment Data Validation (RADV) audit and any other chart coding functions, by performing moderately complex medical record review and coding, ensuring compliance with all applicable Federal, State and/or County laws and regulations related to coding and documentation guidelines. The development and ongoing maintenance of the Risk Adjustment Coding guidelines, as well as, guiding junior coding specialists are included in the job responsibilities. ESSENTIAL FUNCTIONS: Verifies accuracy, completeness, and appropriateness of diagnosis codes based on medical documentation provided at all levels of complexity. Utilizes appropriate coding guidelines and recommends any changes to diagnosis codes based on chart review. Achieves and maintains coding accuracy levels greater than 90%. Works with vendors,...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: This position serves as a key liaison between the Cost Accounting/Finance function and the other divisions throughout the organization. This role is responsible for analyzing data, performs various Cost Accounting functions requiring knowledge of the theory and practice of recording, classifying, examining, and analyzing corporate data and financial transactions of the organization. This position also provides financial support to the business, through analysis of cost accounting documents and results; and interacts regularly with business owners, data suppliers, and other finance division teams. This role is responsible for optimizing accounting systems and processes, enhancing reporting capabilities and ensuring accurate and efficient financial operations. Additionally, this role helps prepare and produce statutory and financial reports for regulatory bodies and internal stakeholders, along with analyzing...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: Manages and implements custom extensions within TriZetto Facets application. This role plays a critical part in enabling seamless integration, configuration, and performance of core payer functions like enrollment, claims, billing, and customer service. Focuses on building robust custom extensions that align with business workflows, regulatory requirements, and evolving enterprise technology strategies. ESSENTIAL FUNCTIONS: Develop, enhance, and support extensions and custom modules. Analyse business and technical requirements to create scalable extension solutions within the Facets ecosystem. Collaborate with business analysts, architects, QA, and DevOps teams to deliver high-quality software in an Agile environment. Support defect resolution and performance tuning of existing Facets extensions. Participate in core reviews and documentation of technical designs. Work closely with integration teams...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: Performs complex analysis, design, development, 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, develops/codes, tests, and documents critical and complex application programs for computer systems. Works with appropriate stakeholders to define system scope and objectives and establish baselines. Establishes project standards and processes. Breaks down software requirements and creates highly complex systems. ESSENTIAL FUNCTIONS: Perform technical detail design, coding, testing of applications. Serves as subject matter expert for both customer and internal discussions related to maintaining and enhancing existing software systems. Develop and/or analyze interface design documentation. Comply with hardware and software systems standards and procedures. Deliver large...

CareFirst BlueCross BlueShield Resp & Qualifications Join our Platform team to play a key role in shaping CareFirsts next-generation Integration Platform, with a strong emphasis on MuleSoft as a cornerstone of our future-state architecture. This role drives innovation, defines technical strategy, and champions developer enablement to accelerate adoption of an API-first, product-based integration approach. By leveraging MuleSofts platform capabilities, you will help streamline execution, enable reusability, and deliver scalable, cost-effective solutions that power our enterprise portfolio. CareFirst is undergoing a digital transformation that demands enterprise agility and a modernized technology stack to increase speed-to-market and broaden our impact. The Integration & Interoperability organization is at the forefront of this shift, advancing Scaled Agile Framework (SAFe) practices across the enterprise. As a Sr. Platform Engineer, you will lead MuleSoft platform...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: The Risk Adjustment Coding Operations Supervisor supports the execution of the corporate coding strategy across Medicare Advantage, Medicaid, and ACA markets. This role ensures operational compliance by supervising day-to-day activities, monitoring performance metrics, and facilitating cross-functional internal and external collaboration to drive cost-effective coding operations. This role is also responsible for overseeing regulatory compliance through interrater reliability monitoring and surveillance of high-risk conditions from the accurate collection, submission, and validation of risk adjustment data. Ensuring compliance with regulatory standards that ensure accurate and complete performance under various risk adjustment programs. ESSENTIAL FUNCTIONS: Supervise day-to-day activities and operational processes of the coding operations team - including HCC coding, auditing and data submission to CMS...