Senior Medicare Compliance Analyst - Embedded CAP

CareFirst, Inc.; Baltimore (MD); À distance; USD 70 000 - 139 000; Plein temps

Résumé du poste

CareFirst BlueCross BlueShield seeks a Senior Embedded Compliance Analyst to support Medicare Advantage regulatory activities, monitor KPIs/KRIs, and oversee CAP remediation. The role involves investigations, post-implementation checks, and collaboration with Ethics & Compliance to mature the program.

The ideal candidate has 5 years in health insurance compliance, preferred CHC/CRCMP/CCEP certifications, and strong analytical and communication skills. Travel up to 5% may be required.

Qualifications

• Bachelor's degree required; 4 additional years of relevant work experience may substitute.
• 5 years of experience in health insurance industry, managed care, or related compliance programs.
• Preferred certifications: CHC, CRCMP, CCEP, Lean Six Sigma; others welcome.
• Knowledge of CMS programs (Medicare/Medicaid) and regulatory frameworks.
• Strong analytical and reporting abilities; effective communication with stakeholders.

Responsabilités

• Monitor compliance performance for Medicare Advantage using KPIs/KRIs.
• Collaborate with business owners to address remediation and ensure CAP implementation.
• Support post-implementation procedures validating compliance requirements.
• Investigate and address compliance incidents with timely, professional responses.
• Coordinate with Corporate Ethics & Compliance on Code of Conduct and third-party conduct.

Connaissances

Regulatory compliance

Stakeholder management

Analytical thinking

Regulatory reporting

Communication skills

Formation

Bachelor's Degree in Business Administration, Healthcare Compliance or related field

4+ years relevant work experience in lieu of degree

Outils

Word

Excel

Database management

Description du poste

CareFirst BlueCross BlueShield seeks a Senior Embedded Compliance Analyst to support Medicare Advantage regulatory activities, monitor KPIs/KRIs, and oversee CAP remediation. The role involves investigations, post-implementation checks, and collaboration with Ethics & Compliance to mature the program.

The ideal candidate has 5 years in health insurance compliance, preferred CHC/CRCMP/CCEP certifications, and strong analytical and communication skills. Travel up to 5% may be required.