Claims Configuration Jobs in Baltimore, MD (NOW HIRING)

Resp & Qualifications

PURPOSE: 
The Policy Coordinator will support the end-to-end implementation of medical and payment policies by coordinating cross-functional activities required to operationalize policy decisions. This role ensures business readiness across impacted functions, including claims, configuration, provider communications and operations, and provides support during testing, implementation, and post-implementation validation. We are looking for an experienced professional to work remotely from within the greater Baltimore/Washington metropolitan area. The incumbent will be expected to come into a CareFirst location periodically for meetings, training and/or other business-related activities.
ESSENTIAL FUNCTIONS:

• Coordinates cross-functional activities required to implement medical and payment policy changes, including alignment across claims, configuration, provider operations, network management, and compliance teams. Tracks key milestones and ensures readiness for policy go-live.
• Supports business readiness activities, including impact assessments, readiness checklists, and coordination of implementation plans. Works with stakeholders to identify operational, staffing, and workflow impacts associated with policy changes.
• Coordinates testing activities related to policy implementation, including user acceptance testing (UAT), validation of claims adjudication logic, and issue tracking/resolution. Ensures testing results are documented and communicated to stakeholders.
• Maintains implementation documentation, including timelines, status reports, risks, and dependencies. Provides regular updates to leadership and ensures transparency across teams.
• Supports post-implementation monitoring by coordinating issue tracking, identifying gaps in execution, and escalating risks or defects to appropriate stakeholders for resolution.

QUALIFICATIONS:
Education Level: Bachelor's Degree in Health Administration, Business, Finance or related discipline 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.

Licenses/Certifications Preferred:

• Certified Coder (CCS or CPC)-AHIMA or AAPC AAPC Certified Professional Coder (CPC) or AHIMA Certified Coding Specialist (CCS). 

Experience:  Experience in health plan operations, project coordination, policy implementation, claims operations, or related functions.
Preferred Qualifications:

• Experience working in a health plan environment (Medical Policy, Payment Policy, Claims, or Operations).
• Experience coordinating cross-functional projects or implementations.
• Familiarity with claims systems, configuration processes, or policy governance. 

Knowledge, Skills and Abilities (KSAs)

• Strong organizational and coordination skills across multiple teams and stakeholders.
• Ability to manage multiple workstreams and meet deadlines. 
• Strong communication skills with ability to translate policy decisions into operational tasks
• Working knowledge of managed care, claims processes, and policy implementation workflows. 
• Ability to identify risks, track issues, and escalate appropriately. 
• Use of Microsoft Office applications (Excel, PowerPoint, Word) and project tracking tools. 
• 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: 51,264 - 101,816

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 responsibilities 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).

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.

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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