Jobs with CareFirst BlueCross BlueShield
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CareFirst BlueCross BlueShield
Lead Contract Specialist (Remote)
CareFirst BlueCross BlueShield
Resp & Qualifications PURPOSE: The Lead Contract Specialist will play a pivotal role in taking charge of the processes including facilitating meeting with various levels of leadership and educat...
Nov 14, 2024
Reston, VA
CareFirst BlueCross BlueShield
Senior Pharmacy Business Consultant (Remote)
CareFirst BlueCross BlueShield
Resp & Qualifications Although this position is "REMOTE", candidates must live in the MD, DC, VA, PA, DE, etc. area in order to travel into the local offices on occasion.  PURPOSE: The Sr....
Nov 14, 2024
Baltimore, MD
CareFirst BlueCross BlueShield
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Nov 14, 2024
Baltimore, MD
CareFirst BlueCross BlueShield
Clinical Appeals Supervisor - RN (Hybrid)
CareFirst BlueCross BlueShield
Resp & Qualifications PURPOSE: The Clinical Appeals Supervisor (RN) directs and coordinates the accurate implementation of the clinical appeal process for members and providers who appeal on beh...
Nov 9, 2024
Baltimore, MD
CareFirst BlueCross BlueShield
Resp & Qualifications PURPOSEThe Director, Commercial Accounts - Labor Sector, is responsible for the direction and oversight of the labor service team of Account Consultants charged with retention a...
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Lead Contract Specialist (Remote)
Reston, VA
Nov 14, 2024

Resp & Qualifications

PURPOSE: 
The Lead Contract Specialist will play a pivotal role in taking charge of the processes including facilitating meeting with various levels of leadership and education and implementation on service level requirements (SLRs), which are a key cornerstone of the work performed within the organization. Under the direction of the leadership this role will conduct continual improvement assessments to maximize the value of key stakeholder activities and deliverable; to ensure projects meet contractual obligations.  Provides guidance and/or training to others across the organization to ensure compliance with SLRs and other contractual obligations. This role may also serve as a contract negotiator; in working with leadership, legal, key customers and BCBSA; to effect change to the current contract, development of contract amendments and/or change orders, interpretation of current contract and contractual deliverables. 


ESSENTIAL FUNCTIONS:

  • Contract liaison between the organization and key external partner and/or customers to ensure contract compliance, contract performance, issue resolution and risk mitigation, delivery of contractual reports and project support, Service Level Requirements (SLRs) reporting/annual negotiations and educating the organization regarding SLRs and contractual obligations to ensure compliance.
  • Applies a depth of knowledge, skills, and abilities to research and analyze complex issues in response to management request(s) and presents results as required. Initiates, creates and develops metrics, statistics, reports, budgets, and research and analysis. Provides guidance and assistance to staff across the organization to ensure contractual compliance with key external partner and/or customers.
  • Position interacts with Executive management, key internal partners, IT, Finance and Legal on varied IT projects/initiatives, analysis and reporting functions. SME in IT project support to resolve issues and/or mitigate risks while ensuring contractual compliance. Coordinates and verifies delivery of monthly and annual packages to key external partner and/or customers are of superior quality and timely. Review financial data for presentation to upper management.
  • Initiates and designs complex department communications, policies and procedures regarding contractual adherence for both internal and external usage, coordinates internal reporting requirements for the department, creates presentations for management, educates teams and management on issues to support and ensure contract compliance.

    SUPERVISORY RESPONSIBILITY:
    Position does not have direct reports but is expected to assist in guiding and mentoring less experienced staff. May lead a team of matrixed resources.

    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.

    Experience: 8 years experience in health insurance benefit/product knowledge, benefits delivery systems or contract management.

    Knowledge, Skills and Abilities (KSAs)

    • Excellent communication skills both written and verbal.
    • Knowledge of contracting strategies.
    • Ability to provide contract compliant solutions with partners and functional teams.
    • Proficient in Microsoft Office applications.
    • Strong investigative skills.
    • Knowledge of accounting principles/practices and analysis/reporting of financial data.
    • 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: $79,920 - $158,730

    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

    Contract 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-KT1 

    PDN-9d7bd2bc-64c1-431d-b417-c49047c8519c
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Lead Contract Specialist (Remote)
CareFirst BlueCross BlueShield
Reston, VA
Nov 14, 2024
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