Resp & Qualifications

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.

PURPOSE:

Manages the daily activities of a multi-functional operations area. Oversee day-to-day configurations within GuidingCare, the clinical platform supporting Care Management, Utilization Management and Appeals & Grievance, ensuring system alignment with CareFirst plan requirements across all health service functions across all lines of business.

ESSENTIAL FUNCTIONS:

• Achieves operational objectives by contributing information and analysis to strategic plans and reviews; preparing and completing action plans; implementing production, productivity, quality, customer-service standards; identifying and resolving problems; identifying, developing, and implementing system improvements. Meets departmental financial objectives by estimating requirements; preparing an annual budget; scheduling expenditures; analyzing variances; initiating corrective actions. Direct functional testing activities to validate system accuracy, identify defects, and ensure overall platform stability.

• Determines operations strategies by conducting needs assessments, performance reviews, capacity planning, and cost/benefit analyses; identifying and evaluating state-of-the-art technologies; defining user requirements.

• Manages employee outcomes by recruiting, selecting, orienting, training, assigning, coaching, counseling, and disciplining employees; communicating job expectations; planning, monitoring, appraising, and reviewing job contributions; planning and reviewing compensation actions; enforcing policies and procedures.

• Maintains and improves departmental operations by monitoring system performance; identifying and resolving operations problems; managing process improvement and quality assurance programs; installing upgrades. Champion a culture of continuous improvement, identifying and implementing optimizations to enhance system functionality and user experience.

• Prepares day to day operations performance reports by collecting, analyzing, and summarizing data and trends. Working knowledge of both Tableu and Power BI required.

SUPERVISORY RESPONSIBILITY:

This position manages people.

QUALIFICATIONS:

Education Level: Bachelor's Degree in Business or related field 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.

Experience: 5 years progressive experience in operations with time spent in a call center, claims, billing and enrollment, operations environment. 1-year supervisory experience or demonstrated progressive leadership.

Preferred Qualifications:

• Familiarity with health insurance operations, claims processing, and/or healthcare systems; direct experience with GuidingCare platform required.

• Expert knowledge of operational metrics across UM, CM and AG tracked through clinical applications.

• Proficient knowledge of GuidingCare platform including user workflows for internal and external providers.

Knowledge, Skills and Abilities (KSAs)

• Knowledge of call center operations, claims and/or enrollment and billing and workflows.

• Strong presentation skills.

• Highly proficient in Microsoft Office programs.

• Excellent communication skills both written and verbal.

• Ability to plan, review, supervise, and inspect the work of others.

• 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: $85,600 - $158,895

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

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REQNUMBER: 19794