Senior Medicare Compliance Analyst, Embedded Programs

CareFirst; Baltimore (MD); Remote; USD 70,000 - 139,000; Full time

Job summary

CareFirst is seeking a Senior Embedded Compliance Analyst to support the Medicare Advantage program by overseeing the annual Compliance Workplan and monitoring regulatory guidelines. The role requires analyzing KPIs/KRIs, coordinating remediation actions, and ensuring CAPs are implemented with documented follow-up.

Ideal candidates will have a healthcare compliance background and CMS program experience, with strong analytical, communication, and cross-functional collaboration skills to drive

Qualifications

• 5 years experience in health insurance industry, managed care and government programs, health insurance compliance programs.
• Healthcare Compliance certification(s).
• Experience with CMS programs (Medicare/Medicaid) and project management.
• Process Improvement tools training in Six Sigma, Lean, or other BPM tools.

Responsibilities

• Monitor compliance performance and KPIs/KRIs for Medicare Advantage.
• Educate impacted areas on regulatory rules and contractual requirements.
• Track CAP implementation and remediation efforts.
• Perform investigations and due diligence for compliance incidents.
• Collaborate with Corporate Ethics & Compliance on Code of Conduct and related policies.

Skills

Healthcare compliance

Regulatory analysis

KPI / KRI monitoring

Relationship management

Auditing & investigations

Education

Bachelor's degree in healthcare compliance

CHC certification

CRCMP certification

Lean Six Sigma

CCEP certification

Tools

Microsoft Word

Advanced Excel

Database management

Job description

CareFirst is seeking a Senior Embedded Compliance Analyst to support the Medicare Advantage program by overseeing the annual Compliance Workplan and monitoring regulatory guidelines. The role requires analyzing KPIs/KRIs, coordinating remediation actions, and ensuring CAPs are implemented with documented follow-up.

Ideal candidates will have a healthcare compliance background and CMS program experience, with strong analytical, communication, and cross-functional collaboration skills to drive