17 operations technician 1 jobs found in Baltimore

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: Develops and Implements strategy for the Experience and Digital Marketing product line and is responsible for the product planning and execution throughout the Product Lifecycle, including gathering and prioritizing product and customer requirements, defining the product vision. Working with Product Owners, IT, and other stakeholders to prioritize product and customer requirements against the business strategy, product roadmap, and value drivers. Partners closely with engineering to ensure we deliver winning products that meet CareFirst and member needs. Oversees the product roadmap development process ensuring it includes the UX, design teams, operations managers, engineering managers, and finance teams. Confirms project deadlines with support from the product owners and delivery team. To ensure the product development stages meet internal and external stakeholders'. expectations. Also, provide timely and...

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: 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 DC/MD/VA The Data Analytics Intern role exists as a hiring strategy to bring in students enrolled in an accredited college or university who are pursuing at least a Bachelors degree in analytical and/or data visualization related fields to learn the business and technical side of healthcare from the ground up. Data and Analytics creates cutting edge analytic tools/visualizations to drive insights and faster decision making within the organization and provides critical support for key corporate initiatives. This role will require interaction with project stakeholders and business partners within the organization. This position will use analytically derived insights to develop and test solutions that enhance consumer engagement, improve health outcomes and reduce health care costs. This is a fast-paced, collaborative, and iterative environment requiring quick learning, agility and flexibility. This is a Year-Round...

CareFirst BlueCross BlueShield Resp & Qualifications We're hiring for a Lead Data Analyst - Value-Based Care Reporting on the Health Economics and Reporting team at CareFirst! 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 other business-related activities. We are not looking for generalists who may have an IT background and various credentials like Scrum, Agile, etc. 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....

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: Utilizes data analytics and contributes to a set of business initiatives designed to help business partners extract value from information. Develops data visualizations for analysis, problem-solving, and business solutions. We are not looking for generalists who may have an IT background and various credentials like Scrum, Agile, etc. 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 ESSENTIAL FUNCTIONS: Mines and extracts data and applies algorithms to derive insights. Contribute to the analytics, reporting and data governance activity related to Cost of Care Reporting, including Ideation support,...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: Utilizes data analytics and contributes to a set of business initiatives designed to help business partners extract value from information. Develops data visualizations for analysis, problem-solving, and business solutions. We are not looking for generalists who may have an IT background and various credentials like Scrum, Agile, etc. 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 ESSENTIAL FUNCTIONS: Mines and extracts data and applies algorithms to derive insights. Contribute to the analytics, reporting and data governance activity related to Cost of Care Reporting, including Ideation support,...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: This role directly supports the Underwriting teams rating system by defining, designing, and developing system requirements. The position involves coordinating the design of subsystems, integrating total systems, and resolving program support deficiencies. The engineer will conduct independent technical investigations, perform elaborate data validation studies, and analyze system problems to develop effective innovation solutions. Responsibilities include designing, coding, testing, and documenting software applications. The role also requires gathering requirements, conducting advanced software analysis, and developing solutions. Additional duties involve integrating systems, designing architecture, and selecting suitable technologies and tools according to established project standards and procedures. This position collaborates closely with end-users and stakeholders to define system scope and...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: Provides strategic and tactical planning, as well as, knowledge services relating to the implementation of key mandate initiatives, covering a broad range of legislative and regulatory matters including: Federal, BCBSA, Government Programs, State. Provides internal and external liaison functions, workflow, customer service, communications, training, strategic delivery, efficiency, cost reduction and skill development initiatives. We are looking for an experienced professional to work remotely. The incumbent will be expected to come into a CareFirst location periodically for meetings, training and/or other business-related activities. ESSENTIAL FUNCTIONS: Analyzes legislation and regulations as it relates to CareFirst and creates high level compliance requirements. Primary/dedicated Regulatory point of contact for Project Managers who implementation projects. Takes a lead role in various...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: To support the prevention, reduction of and/or recuperation of losses to CareFirst through the clinical review of medical records and claims, resulting in the savings and/or recovery of funds. Responsible for providing clinical knowledge to the SI team to support both prepayment reviews and/or post-payment investigations. ESSENTIAL FUNCTIONS: Review of medical records and claims. Investigate potential fraud and over-utilization by performing complex medical reviews of claims and medical records. The claims may be in a pre or post payment environment. Provide a detailed but concise analysis to communicate findings about the ability to pay or deny a claim or claim lines using clinical and/or coding, billing, or reimbursement knowledge. Maintain appropriate records and supporting documentation regarding findings in accordance with departmental standards. Process all assigned claims or batch case reviews...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: This position will support the modernization and redesign of the utilization management department through thoughtful contributions to process analysis, mapping, and managing process improvements made in alignment with goals for the department and organization. Supports the analysis and evaluation of business problems and the development of solutions to address identified problems, using deep understanding of the utilization management function and workflows. Provides a single point of contact for those projects. Takes projects from original concept through final implementation. Assignments typically include problem definition, evaluation of requirements, and facilitation of the implementation of systems and/or process to meet business and user requirements. We are looking for an experienced professional to work remotely from within the greater Baltimore metropolitan area. The incumbent will be expected to...

CareFirst BlueCross BlueShield Resp & Qualifications This is a hybrid role. Candidate must be local to DMV offices to attend in-person meetings on a regular basis. PURPOSE: Lead the Narrative. Shape the Strategy. Win the Business. Are you a master storyteller with a strategic mindset and a passion for driving business growth? Join our dynamic team as a Proposal Manager, where your expertise will directly influence how we present our value to clientsand win their trust. As a Proposal Manager, youll be the architect behind high-impact, customer-focused proposals that showcase our solutions and set us apart in the marketplace. Youll lead the full proposal lifecyclefrom planning and development to deliveryensuring every response is compliant, compelling, and strategically aligned with our mission. ESSENTIAL FUNCTIONS: Lead the Charge: Manage all aspects of complex proposal requestsresearching, writing, editing, and ensuring compliance with bid requirements....

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: The Payment Integrity Analyst is responsible for conducting research and analysis and reviewing billing requirements, provider manuals, medical policies, and other sources as needed to identify new overpayment concepts, as well as validate all prospective and retrospective overpayment results; communicating findings to the Payment Integrity Workgroup and Management. The incumbent will be responsible for assessing and implementing new technology and recommend improvement to existing processes. In addition, they will be responsible for providing thorough analysis on their findings. ESSENTIAL FUNCTIONS: Identifies, develops, and implements new concepts that will target claim overpayment scenarios. Performs analysis on claims, provider data, enrollment data, medical policies, claim payment policies for payment integrity concepts for recovery opportunities. Performs analysis of business unit data 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...