75 operations associate jobs found

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: We are looking for an experienced Care Manager to support our Maryland Medicare enrollees. Under minimal supervision, the Care Manager researches and analyzes a member's medical and behavioral health needs and healthcare cost drivers. The Care Manager works closely with members and the interdisciplinary care team to ensure members have an effective plan of care and positive member experience that leads to optimal health and cost-effective outcomes. 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. Bi-lingual / Spanish speaking a plus! ESSENTIAL FUNCTIONS: Identifies members with acute/complex medical and/or behavioral health conditions. Engages onsite and/or telephonically with member, family and...

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: Responsible for planning and managing day to day activities regarding network development. Responsibilities include provider recruiting/contracting for commercial business and government programs, new networks, coordination with the Payment and Practice Transformation Team for value-based contracts, managing department-related RFP responses, tracking hospital-based practices and provider resignations, maintenance of participation agreements, reporting departmental metrics and overall management of all non-standard contract negotiations including single case...

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 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: 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: 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...

Transamerica Job Family Actuarial About Us At Transamerica, hard work, innovative thinking, and personal accountability are qualities we honor and reward. We understand the potential of leveraging the talents of a diverse workforce. We embrace an environment where employees enjoy a balance between their careers, families, communities, and personal interests. Ultimately, we appreciate the uniqueness of a company where talented professionals work collaboratively in a positive environment - one focused on helping people look forward and plan for the best life possible while providing tools and solutions that make it easier to get there. Who We Are We believe everyone deserves to live their best life. More than a century ago, we were among the first financial services companies in America to serve everyday people from all walks of life. Today, we're part of an international holding company, with millions of customers and thousands of employees...

AIT - Arctic Information Technology, Inc Overview: JOB SUMMARY: The Associate Service Delivery Manager position is responsible for delivering our IT managed services to a portfolio of client accounts with the support of a cross-functional team. This role involves helping designDATA safeguard our revenue, retain our clients, grow our accounts, and spearhead projects to modernize client infrastructure. Responsibilities: ESSENTIAL FUNCTIONS: Account Management Manage 8 to 10 client accounts with the support of a dedicated cross functional team Drive contract renewal and project sales activities within assigned accounts to meet service renewal and expansion targets, to include cultivating leads and generating and presenting proposals Motivate clients to adopt designDATA infrastructure and IT offerings Analyze clients' environments and needs regularly to identify new sales opportunities Meet with clients regularly to ensure satisfaction with our services...

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: 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 Although this position is remote, candidates must live in the MD, DC, VA area in order to travel into the offices on occasion. PURPOSE: The Client Onboarding Manager (OM) serves as the primary point of contact for new clients and provides them with an excellent experience throughout the onboarding lifecycle. The OM works directly with the Sales Team to ensure a smooth transition of new customers. Responsible for guiding new clients through their first 90- 120 days of implementation by creating and delegating tasks to appropriate stakeholders, managing those tasks to their completion, maintaining the implementation schedule, leading efforts in identifying potential risks and resolving challenges, and providing transparent communication to all stakeholders. The OM is an advocate for new clients to ensure needs are met. Solely responsible for the overall success of new business implementations, setting and managing...

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: The Small Group Existing Business Sales Consultant serves as the primary strategist and revenue leader for a defined territory of small group brokers, and their associated employers. Unlike traditional account service roles, this position will not manage day-to-day broker service issues those are handled by the Broker Service Team. Instead, the consultant is responsible for retention strategy, renewal positioning, revenue optimization, and broker ecosystem engagement. This role mirrors the strategic expectations of our manager-level sales leadership: driving clarity, elevating performance, and ensuring our market voice is consistent, compelling, and effective. The consultant functions as the internal authority on the assigned relationships the person the broader organization turns to for insights on portfolio health, competitive threats, renewal decisions, and growth strategy. ESSENTIAL FUNCTIONS:...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: The Assistant General Counsel provides a range of highly specialized legal services in support of the General Counsel, Deputy General Counsel, 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. This position provides direct support to the Commercial Markets Sales and Marketing areas of the Company and requires substantive knowledge of ERISA, HIPAA and the Public Health Services Act with respect to group health plans. 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, contractual and operational...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: The Associate General Counsel provides a complete range of legal services in support of the Assistant General Counsel, Litigation General Counsel, and the Division(s), Department(s), and/or specialized areas of legal practice to which the position is assigned with a focus on regulatory, compliance, litigation, and employment law. ESSENTIAL FUNCTIONS: Provides advice and counsel to management and/or their designees in complex and rapidly evolving areas of the law; evaluates divisional and departmental initiatives and represents the corporations legal interests on intercompany management committees; researches, analyzes and writes legal memoranda and provides legal guidance on a wide variety of legal, regulatory, contractual, compliance, corporate governance and operational matters, including the interpretation and implementation of legislation; assists with and/or supports representation of the...

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: 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...