Remote Claims Processing Jobs in Maryland (NOW HIRING)

Resp & Qualifications

PURPOSE: 
Responsible for establishing strategic technology direction and creating solution architecture for large complex initiatives/projects. Responsible for the strategic design of technical solutions for complex business problems that are in line with established and emerging technology standards, patterns, and best practices. Primary accountability for architecture work takes place during the lifecycle of major transformation/modernization Initiatives/projects, from planning through implementation. Provides technical oversight and strategic direction to IT project teams in order to deliver key solutions to business problems.
ESSENTIAL FUNCTIONS:

Translate business strategy into solution architecture:

• Accountable for leading the Solution Architecture deliverables for large complex portfolio, program or product line, which aligns with enterprise architecture and links the high-level architecture, business requirements, and technology standards into a cohesive solution. Responsible for defining and communicating a shared technical and architecture vision across the portfolio/program. Provides foundational architecture and creates technical alignments for the full solution balancing the needs from both business and domain architecture. Has an expert knowledge of integration solutions and communicates with business owners, domain architects, other Solution Architects, technical delivery staff, and key technical stakeholders, including Security, Data, and Technology Centers of Excellence. Collaborates with peer Solution Architects to ensure that the proposed solution is consistent with other designs.

Leads Solutions Design and Analysis:

• Leads solutions design incremental and analysis of complex projects/issues that require in-depth knowledge across multiple technical areas and business segments. Responsible for defining components and subsystem, end to end integration architecture and their interface, as well as the target deployment aligning with target architecture vision. Responsible for recommendations of critical design decisions and trade-offs. Ensures seamless integration of new applications with enterprise applications in the ecosystem by selecting the technology, tools or services that provides the best solution for business needs.  

Orchestrate solution delivery:

• Accountable for communicating solution architecture and getting it implemented. Defines and directs implementation governance activities associated ensuing solution architecture compliance with the intent and overall enterprise architecture. Responsible for creates architecture and technical enablers to support architecture runways. Supports the implementation of enablers and ensures solution of technical and architecture enablers meet solution objectives.

Facilitate and collaborate to drive business value:

• Partners with the project manager, product managers technical delivery manager, requirements manager, and business leadership in the definition of the Solution Architecture.Work closely with product managers, product owners to ensure a robust architecture runways that can support future business needs through product lifecycle. Provide consulting supports to domain architects and solution delivery team to ensure project and product aligned with overall enterprise architecture.

Maintain industry and technology Expertise:

• Maintains knowledge of and apply industry best practices for architecture, participates in cross-functional component architecture teams, and develops future architecture and technology migration plans. Evaluates and selects from existing and emerging technologies options best fitting business and IT strategic needs.

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 in Computer Science, IT 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: 10 years' experience as an infrastructure architect
Preferred Qualifications:

• Bachelor's degree in computer science or related field preferred.  Experience in the development, implementation, and maintenance of large-scale systems, preferably across multiple hardware and software platforms (in the health care industry).  Experience with intranet development and implementation is a plus. 

Knowledge, Skills and Abilities (KSAs)

• Proficiency in innovating ideas and solutions resulting in tangible and measurable business outcomes.
• Mastery in creating architecture solutions within the enterprise architecture future state for technological acceleration of value outcomes, and effectively present and persuade key decision makers to invest in this acceleration. 
• Must have recent solution/domain architecture experience with  Facets G6 real-time and batch claims processing, pre-adjudication validation, EDI-based transaction data management,  claim editing engines, and third-party integrations with partner organizations that provide these services.
• Must have experience working with claims processing, enrollment, billing & payments, underwriting, partner programs, business operations, and benefit management business functions either in a commercial or government area (both preferred). 
• Additional architecture experience in one or more technology platforms (Salesforce Health Cloud/Data Cloud, other Healthcare specific platforms, MuleSoft, Kafka, , Azure Fabric) 
• Expertise with two or more architecture domains (enterprise architecture, solution architecture, software development, data, integration, interoperability, cloud, artificial intelligence) and their associated architecture frameworks, standards/patterns, methods and tools. Experience overseeing and driving third-party solution architecture engagements and outcomes.
• Knowledge of healthcare data interchange standards (e.g., HL7, FHIR, X12) and regulatory requirements (HIPAA, CMS, NCQA).
• Experience contributing to portfolio rationalization and/or technical debt remediation initiatives at an enterprise level
• Ability to motivate and influence others so that architecture objectives are met in a timely and consistent manner           
• Ability to collaborate with stakeholders to develop high quality, architecture solutions and technical designs based on approved standards. 
• Ability to coach peers and team members across multiple business and technology disciplines. 
• Ability to provide solution architectural consulting to business leaders, program leaders, product owners, and delivery teams
• Ability to set architectural solutions across multiple initiatives or domains aligned to platform/product roadmaps and facilitate implementation of approved solution.              
• Effective organizational/interpersonal/relationship management, analytical/systems thinking, communications (written and verbal) and collaboration across multiple business and IT teams.
• Recent payer or provider healthcare experience a plus.

Salary Range: 155,600 - 278,135

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

#LI-LD1