- CareFirst (Baltimore, MD)
- …using modernized data implementations of lakes, warehouses, and cloud-based systems . Enforce and enhance strategies for storage, integration, and retrieval ... addition to the required work experience. **Licenses/Certifications:** + Certified System Architect Upon Hire Preferred. + Certifications in cloud… more
- CareFirst (Baltimore, MD)
- …care and case management to engage members/enrollees, their families and other support systems in discharge planning. The role will function as a liaison working ... onsite at the assigned hospital up to 5 days at a hospital health system in Maryland. Occasional weekend work may also be required, both at management's sole… more
- CareFirst (Baltimore, MD)
- …and assignment. Leads a team in the analysis of existing business processes and systems to identify, document, elevate the presence of risks and trends within ... systems and processes that may be non-compliant with requirements...and grievances (Medicare, Medicaid, DSNP) + Knowledge of CareFirst system , Member/Provider Service, Claims, Utilization or Care Management experience… more
- CareFirst (Baltimore, MD)
- …an in-depth understanding of the business areas, technologies, partners, subsidiaries, systems , processes, data, and customers in alignment with the CareFirst ... overall engagement model. + Provide expert security guidance for projects, systems , and vendor engagements. + Oversee implementation of technical security measures,… more
- CareFirst (Baltimore, MD)
- …**SUPERVISORY RESPONSIBILITY:** Leads a team utilizing a matrix management system . **QUALIFICATIONS:** **Education Level:** Bachelor's Degree in Business Management ... goals. + Ability to translate business needs as it relates to technology, systems , and vendor platforms. + Ability to identify and shepherd strategic opportunities… more
- CareFirst (Baltimore, MD)
- …needed. Clarifies and ensures consistency of contract benefits with respective system benefit coders. Revises/updates contract forms and templates as appropriate and ... 3 years' experience health insurance benefit/product knowledge and benefits delivery systems **Knowledge, Skills and Abilities (KSAs)** + Strong time-management and… more
- CareFirst (Baltimore, MD)
- …CareFirst products, lines of business, and contracted providers from large health systems to small independent practices. **_We are looking for an experienced people ... Professional (PMP)-PMI **Preferred Qualifications:** + Knowledge of CareFirst operational/claims systems , processes, contracts, and products. + Experience working with… more
- CareFirst (Baltimore, MD)
- …gathering and researching information; examine claim submissions verifying claim and system accuracy as well as liability, validate customer understanding of ... account information by effectively utilizing the business areas enrollment/inquiry tracking system & processes. + Participates in ongoing education related to new… more
- CareFirst (Baltimore, MD)
- …strategic needs of the organization with respect to system , information, functional/non-functional needs, performance and security/regulatory requirements. Create ... to the required work experience. **Licenses/Certifications Preferred:** + Certified System Architect Upon Hire. **Experience:** 8 years Experience in Architecture… more
- CareFirst (Baltimore, MD)
- …of sources to delivery expected outputs. + Develops and maintains infrastructure systems (eg, data warehouses, data lakes) including data access APIs. Prepares and ... and execute quality control procedures across datasets sourced from multiple systems . + Continuously improve data engineering expertise by attending workshops,… more