30 senior compensation analyst jobs found

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: This role is primarily remote with occasional in office team meetings. Provides advanced expertise in developing and maintaining reports, dashboards and data repositories to meet the business intelligence requirements of the organization. Provides data, analysis and requirements in support of a complex reporting and analytics environment. Serves as a subject matter expert in projects related to the data analysis and reporting tools technology. ESSENTIAL FUNCTIONS: Fulfill complex regulatory reporting requirements by understanding the external request and working with IT and business resources to provide CareFirst data into mandated reporting within required timelines. Develops client/customer presentations and reports with a high degree of a more complex nature. May develop innovative best practices and industry bench marking for process measurement and identify indicators for future improvement...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: The Senior Medicare Encounters Risk Adjustment Analyst assumes a pro-active approach in ensuring the accuracy and integrity of key risk adjustment performance metrics through coordination of analytical processes, investigation and interpretation of CMS risk score methodology, risk score calculation, enrollment, premiums, medical and pharmacy claims, and provider data. Incumbent is responsible for performing complex analyses and problem resolution including data integrity extraction, report design, report build and solution deployment. Additional responsibilities include establishing and maintaining business process and technical workflow documents, collaborating with multiple stakeholders at various levels throughout the Company, as well as external entities, providing coordination and support as required. ESSENTIAL FUNCTIONS: Accurately monitor and reconcile submitted encounters against response...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: The Senior Medicaid Encounters Risk Adjustment Analyst assumes a pro-active approach in ensuring the accuracy and integrity of key risk adjustment performance metrics through coordination of analytical processes, investigation and interpretation of Maryland Medicaid risk score methodology, risk score calculation, submissions, enrollment, premiums, medical and pharmacy claims, and provider data. Incumbent is responsible for performing complex analyses and problem resolution including data integrity extraction, report design, report build and solution deployment. Additional responsibilities include establishing and maintaining business process and technical workflow documents, collaborating with multiple stakeholders at various levels throughout the Company, as well as external entities, providing coordination and support as required. ESSENTIAL FUNCTIONS: Accurately monitor and reconcile submitted...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: The Senior ACA Encounters Risk Adjustment Analyst assumes a pro-active approach in ensuring the accuracy and integrity of key risk adjustment performance metrics through coordination of analytical processes, investigation and interpretation of HHS risk score methodology, risk score calculation, enrollment, submissions, premiums, medical and pharmacy claims, and provider data. Incumbent is responsible for performing complex analyses and problem resolution including data integrity extraction, report design, report build and solution deployment. Additional responsibilities include establishing and maintaining business process and technical workflow documents, collaborating with multiple stakeholders at various levels throughout the Company, as well as external entities, providing coordination and support as required. ESSENTIAL FUNCTIONS: Accurately monitor and reconcile submitted encounters against EDGE...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: The Senior Risk Adjustment Business Operations Analyst assumes a pro-active approach in ensuring the accuracy and integrity of key risk adjustment performance metrics through coordination of analytical processes, investigation and interpretation of regulated markets risk score methodologies, risk score calculations, enrollment, submissions, medical and pharmacy claims, and provider data. Incumbent is responsible for performing analyses and problem resolution to meet business operational requirements for Medicare Advantage(MA), Affordable Care Act (ACA) & Medicaid Lines of Business (LOB). Additional responsibilities include establishing and maintaining business policies, process and technical workflow documents, collaborating with multiple stakeholders at various levels throughout the Company, as well as external entities, providing coordination and support as required. We are looking for an experienced...

CareFirst BlueCross BlueShield Resp & Qualifications 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. PURPOSE: Manages end-to-end oversight of business initiatives, specifically related to vendor-based care management services. 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. ESSENTIAL FUNCTIONS: Manages complex program(s) or strategic initiatives that span organizational...

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: Plans, organizes, and manages large scale or complex projects related to vendor-based care management and cost of care initiatives for successful delivery of objectives, on time and within budget. Initiates, engages, and motivates cross-functional teams to deliver results. Identifies and mitigates risk and escalates as needed. Tracks progress and drives documentation to support project needs. Ensures end to end leadership for implementations, integration, business readiness and communications. ESSENTIAL FUNCTIONS: Plans and initiates project resources, prepares...

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: 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: 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: 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 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...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: The Risk Adjustment Manager plays a critical role in the development and execution of the corporate risk adjustment strategy. The role serves as a dedicated resource within the organization for Medicare Advantage, Medicaid and ACA markets, coordinating and leading the end to end strategy by applying improvements and driving cost-effective risk adjustment actions across all organizational populations and products. ESSENTIAL FUNCTIONS: Proactively create, manage and communicate Risk Adjustment related encounter or submission KPIs, OKRs, ROI, action plans, progress and risks within organizational teams. Develop and manage tracking tools, dashboards, and metrics for monitoring the progress of the encounter integrity and submission accuracy in collaboration with cross-functional teams and senior leadership. Conduct impact analysis and formulate actions related to all risk adjustment-related regulatory...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: This role is accountable for directing all aspects related to the monitoring of performance under the Medicaid contract and regulatory requirements and the overall state of compliance for Medicaid and Medicaid products. Reporting to the CEO, Plan Board of Directors, and Corporate Compliance Officer, the incumbent works closely with operational teams, Corporate Compliance, Mandates and Legal departments to resolve complex issues with inter-related legal and Medicaid compliance aspects. ESSENTIAL FUNCTIONS: Direct accountability for establishing an effective compliance program based on the seven core elements of compliance. Directs the activities related to the design, development, implementation and maintenance of compliance programs across all major functional areas and vendors for Medicaid within the division. Ensures internal departments understand and implement CMS and applicable state rules,...