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Resp & Qualifications

PURPOSE:

Configures, tests and documents configuration solutions for provider reimbursement configuration set-up and maintenance, benefit package configuration setup and maintenance, membership configuration set-up and maintenance, setup of code sets used for configuration in benefits & pricing for claims processing, claims editing configuration set-up and maintenance. Analyzes business requirements and objectives towards determining the optimal configuration of the requirements. Creates complex design documents through the assessment of requirements. Assesses alternatives to different designs and chooses best solution to fit business needs. Performs complex data modeling and database design with minimal oversight. Ability to multitask while prioritizing projects.

ESSENTIAL FUNCTIONS:

+ Independently performs hands-on configurations, workflow and process mapping in Guiding Care for core care management and clinical appeals workflows.

+ Assesses how proposed configuration management changes may impact systems sustainment and supportability and makes recommendations on potential process changes.

+ Provides day to day operational support, including product configuration error handling and issue resolution by analyzing back-end logs

+ Participates in government and industry teams in the resolution of complex configuration management issues, with a focus on Guiding Care system functionality and issue resolution.

+ Confirms the adequacy of data for use in functional and physical configuration audits.

QUALIFICATIONS:

**Education Level:** Bachelor's Degree OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience.

Licenses/Certifications Preferred:

+ Certified Configuration Management Professional

**Experience:** 3 years' experience implementing CM policies, plans, and procedures. Experience with issue tracking, software-oriented tasks and project management applications

Knowledge, Skills and Abilities (KSAs)

+ Strong knowledge of configuration processes and principles.

+ Knowledge of SAP and Microsoft Office Applications.

+ Self-starter with an ability to collaborate in a team environment.

+ Excellent communication skills both written and verbal.

+ Knowledge of software development technologies.

+ Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.

**Salary Range:** $53,136 - $105,534

Salary Range Disclaimer

The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilites of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).

Department

Guiding Care Product Management

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Where To Apply

Please visit our website to apply: www.carefirst.com/careers

Federal Disc/Physical Demand

Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.

PHYSICAL DEMANDS:

The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship

\#LI-SS1

REQNUMBER: 21390