26 operations senior associate jobs found in Baltimore

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: 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: 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: 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: Responsible for the attainment, effective management, and profitability of a designated book of business. This position utilizes underwriting judgment and exercises a level of authority. Pricing concessions are permitted up to the designated level of authority without further review. This position works closely with Sales and Account Management to ensure that client needs are met without compromising the corporate objectives. This position is responsible for monitoring financial performance and apprising management as needed. ESSENTIAL FUNCTIONS: Works closely with the Account Manager and Underwriting Manager to provide alternate benefit plans, risk and/or funding arrangements. Update appropriate billing rate files, contracts, internal databases, etc. Complete the renewal process on smaller accounts, complete/update ASO and Stop Loss contracts and quote alternate funding arrangements with assistance...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: Supports Benefit Contract Management (BCM) by assisting or performing accountabilities/tasks that include but are not limited to: revising/updating contract forms and templates; reviewing contract forms, templates and related marketing materials; preparing electronic filings via SERFF; tracking status of filings; creating sample contracts; creating SBCs; organizing and circulating contract related documents; and contributing to BCM strategies and process improvements. ESSENTIAL FUNCTIONS: Reviews, clarifies and/or interprets customized/nonstandard benefit requests; provides information and decisions to operations, account implementation meetings, and other company initiative implementation meetings needed. Clarifies and ensures consistency of contract benefits with respective system benefit coders. Revises/updates contract forms and templates as appropriate and assigned. Assist or performs electronic...

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 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 PURPOSE: The Assistant General Counsel II provides a complete range of highly specialized legal services in support of the General Counsel, Deputy General Counsel, Director, Managing Assistant General Counsel, and executive management in the Division(s) to which the Assistant General Counsel is assigned, and may represent CareFirst, Inc., its subsidiaries, and/or affiliates ("the Corporation") in litigation brought by and or against it. The Senior position is expected to work independently and provide high-level executive support. This position will support the Company's care delivery operations, including comprehensive representation of various provider entities. ESSENTIAL FUNCTIONS: Legal Advice Provides written and oral advice directly to executive management and/or their designees in complex and rapidly evolving areas of the law. Analyzes and provides legal guidance on a wide range of regulatory,...

Northrop Grumman RELOCATION ASSISTANCE: Relocation assistance may be availableCLEARANCE TYPE: SecretTRAVEL: Yes, 10% of the Time Description At Northrop Grumman, our employees have incredible opportunities to work on revolutionary systems that impact people's lives around the world today, and for generations to come. Our pioneering and inventive spirit has enabled us to be at the forefront of many technological advancements in our nation's history - from the first flight across the Atlantic Ocean, to stealth bombers, to landing on the moon. We look for people who have bold new ideas, courage and a pioneering spirit to join forces to invent the future, and have fun along the way. Our culture thrives on intellectual curiosity, cognitive diversity and bringing your whole self to work - and we have an insatiable drive to do what others think is impossible. Our employees are not only part of history, they're making history.At the heart of Defining Possible is our commitment to...

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 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: 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,...

CareFirst BlueCross BlueShield Resp & Qualifications 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 stakeholders and driving to resolution. Research and analyze data flow across complex data ecosystem including operational and analytical data platforms. Manage the collection of business and technical requirements from stakeholders to deliver data driven solution. Produces and reviews technical documentation that is consistent with...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: Supervise the daily operations of the utilization management (UM) department functions to ensure appropriate coordination of health care services and compliance with UR policies/procedures, as well as regulatory and CareFirst's accreditation standards. We are looking for an experienced people 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: Supervise the daily operations of the UM staff. Recruits, retains and develops a high performing team. Evaluates performance of each team member, generates development plans and sets goals within the context of the corporate policies and procedures. Ensure appropriate usage of resources in order to...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE : Supervise the daily operations of the utilization management (UM) department functions to ensure appropriate coordination of health care services and compliance with UR policies/procedures, as well as regulatory and CareFirst's accreditation standards. 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: Supervise the daily operations of the UM staff. Recruits, retains and develops a high performing team. Evaluates performance of each team member, generates development plans and sets goals within the context of the corporate policies and procedures. Ensure appropriate usage of resources in order to...

CareFirst BlueCross BlueShield Resp & Qualifications Candidates must live in the MD, DC, Northern VA area in order to travel into the offices occasionally. PURPOSE: The Broker Support Representative II serves as the primary liaison between our organization and key health insurance broker partners. This role provides strategic operational support, proactive service delivery, and technical expertise to our most prestigious broker agencies and their client accounts. The position requires a customer-focused professional who can build and maintain strong broker relationships while ensuring seamless service delivery and operational excellence. ESSENTIAL FUNCTIONS: Act as the dedicated point of contact for assigned broker agencies, providing comprehensive support for all operational, enrollment, and service-related matters Deliver proactive onsite support to broker partners and account administrators to prevent service disruptions and ensure optimal customer...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: We are seeking a Senior Technical Program Manager to lead cross-functional programs that modernize the enterprise data ecosystem, advance interoperability capabilities, and drive the retirement of legacy platforms. This role will oversee the end-to-end delivery across architecture, engineering, governance, IT partners, and business stakeholders to ensure scalable, compliant, and future-ready data solutions. ESSENTIAL FUNCTIONS: Program Leadership & Execution: Own multi-year roadmaps for enterprise data modernization, interoperability capabilities, and legacy system decommissioning. Manage complex cross-domain programs spanning multiple technical domains and platforms, establishing milestones, identifying risks and dependencies, and coordinating transparency through dashboards, KPIs, and executive updates. Legacy System Retirement: Lead structured deprecation programs for legacy and redundant...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: The Inpatient Management Onsite Care Management Supervisor will direct and coordinate the activities of Onsite Care Management staff, Onsite Clinical Navigators and/or other Registered Nursing roles embedded at a partnering hospital. This role will assist leadership with the development and review of Care Management standards, program criteria, policies, and procedures to ensure quality of care and manage healthcare costs. The incumbent will function as a liaison working onsite at partner hospitals up to 5 days a week. Based on hospital assignments and admission volumes on a week-to-week basis, management may occasionally approve the onsite care management supervisor to perform limited functions telephonically, at its sole discretion.The candidate may also be required to come to the CareFirst office location periodically for meetings, training, or other business-related activities. The candidate's primary...