Jobs in the United States

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Added 4 mins ago
Graywolf Pipe Superintendent in Lebanon, IN
GRAYWOLF INTEGRATED CONSTRUCTION COMPANY
Lebanon, IN
…solutions from design, fabrication, construction, and facility management with a footprint that is nationwide. With more than 45-years of experience in the industry, we have strong…
Added 6 mins ago
Program Manager III, Operational Technology Security, Data Centers
Google
Atlanta, GA · Reston, VA · Seattle, WA · Sunnyvale, CA
5 years of experience in program or project management.
Added 22 mins ago
G
Civil/Site Land Development PE/PM
GPAC
Tampa, FL
- $100,000 to $140,000 USD / year
We are seeking an experienced Professional Engineer (PE) to join our Land Development team in a Project Manager capacity. This individual will play a key role in leading projects, managing…
Added 22 mins ago
G
Job File Coordinator
GPAC
Schertz, TX
- $26 to $30 USD / hour
This company is actively seeking a driven and experienced Job File Coordinator to support its growing restoration operations. An established, IICRC-certified restoration company with 24/7…
Added 22 mins ago
G
Job File Coordinator
GPAC
Boerne, TX
- $26 to $30 USD / hour
This company is actively seeking a driven and experienced Job File Coordinator to support its growing restoration operations. An established, IICRC-certified restoration company with 24/7…
Added 23 mins ago
AC
Benefits Specialist
Aston Carter
Seattle, WA
- $25 to $30 USD / hour
…and administering benefit and time-off plans, providing case management to partners, managers, and third parties. You will ensure adherence to plan terms and communicate information about…
Added 23 mins ago
G
Job File Coordinator
GPAC
Seguin, TX
- $26 to $30 USD / hour
This company is actively seeking a driven and experienced Job File Coordinator to support its growing restoration operations. An established, IICRC-certified restoration company with 24/7…
Added 23 mins ago
G
Job File Coordinator
GPAC
Converse, TX
- $26 to $30 USD / hour
This company is actively seeking a driven and experienced Job File Coordinator to support its growing restoration operations. An established, IICRC-certified restoration company with 24/7…
Added 23 mins ago
G
Job File Coordinator
GPAC
Helotes, TX
- $26 to $30 USD / hour
This company is actively seeking a driven and experienced Job File Coordinator to support its growing restoration operations. An established, IICRC-certified restoration company with 24/7…
Added 23 mins ago
G
Job File Coordinator
GPAC
Universal City, TX
- $26 to $30 USD / hour
This company is actively seeking a driven and experienced Job File Coordinator to support its growing restoration operations. An established, IICRC-certified restoration company with 24/7…
Added 28 mins ago
Project Manager - Digital Health & Wellness Team
Massachusetts Mutual Life Insurance Co.
Boston, MA · Springfield, MA
You’ll be an integral part of our Wellness program in Research & Development, focused on delivering innovative wellness solutions to our customers. Our team operates on a global scale,…
Added 30 mins ago
TM
Grants Manager (20789621)
Tri-City Mental Health Authority
Pomona, CA
- $98,979.43 to $126,325.58 USD / year
The Grants Manager position does not have direct supervisory responsibilities; however, the role involves project management, including coordinating, overseeing, and providing guidance to…
Added 37 mins ago
SC
Principal Consultant
Softchoice Corporati
Denver, CO
- $158,720 to $198,400 USD / year
Identify, shape, and support new business opportunities within existing accounts - introduce new Softchoice capabilities and cross-practice offerings to expand client relationships
Added 37 mins ago
SC
Principal Consultant
Softchoice Corporati
Denver, CO
- $158,720 to $198,400 USD / year
Identify, shape, and support new business opportunities within existing accounts - introduce new Softchoice capabilities and cross-practice offerings to expand client relationships
Added 37 mins ago
SL
: Slalom Flex (Project Based) - Product Intelligence Lead
Slalom, LLC
Denver, CO
- $90 to $95 USD / hour
Role: Slalom Flex (Project Based) - Product Intelligence Lead
Added 37 mins ago
GC
Federal Structures Estimator
Granite Construction
Westminster, CO
- $105,831 to $158,746 USD / year
Comprehend and administer a safety program that provides for a safe work environment that meets or exceeds Granite's Annual Incident Goal, and foster a culture that expects participation at…
Added 43 mins ago
TS
Research Associate 2 (Temp)
Truvian Sciences
San Diego, CA
- $73,000 to $84,000 USD / year
Support troubleshooting and root-cause investigations with guidance from technical leads and management.
Added 43 mins ago
G
Civil/Site Land Development PE/PM
GPAC
Durham, NC
- $100,000 to $145,000 USD / year
We are seeking an experienced Professional Engineer (PE) to join our Land Development team in a Project Manager capacity. This individual will play a key role in leading projects, managing…
Added 44 mins ago
G
Civil/Site Land Development PE/PM
GPAC
Raleigh, NC
- $100,000 to $145,000 USD / year
We are seeking an experienced Professional Engineer (PE) to join our Land Development team in a Project Manager capacity. This individual will play a key role in leading projects, managing…
Added 51 mins ago
Power & Hydrogen Solutions Technical Program Manager, Power & Hydrogen Solutions, GESA
Amazon.com Services LLC
Bellevue, WA
Amazon is seeking an experienced Technical Program Manager (TPM) to join our Global Engineering Services & Analytics (GESA) organization on the Power and Hydrogen Solutions team. In this…
Added 51 mins ago
G
Controls Engineer Manager
GPAC
Appleton, WI
- $105,000 to $135,000 USD / year
Direct mentorship from senior leadership. Learn department management, project scheduling, resource allocation, and operational planning from experienced company leaders.
Added 55 mins ago
Live Fire Structures Test & Evaluation Engineer (Associate, Experienced or Senior)
The Boeing Company
Berkeley, MO
+ Interface with other members of project or program teams, management, and technical staff to define and implement test engineering solutions
Added 55 mins ago
Cybersecurity - Senior Information System Security Manager (ISSM) **Sign on Bonus Potential**
The Boeing Company
Berkeley, MO
+ Works closely with cross-functional teams, including development, operations, and product management, to ensure alignment on project goals and deliverables
Added 55 mins ago
J
Director of Technical Enablement
Jobgether
Remote, United States
- $165,000 to $205,000 USD / year
Excellent project management, communication, interpersonal, and presentation skills, both written and verbal.
Added 55 mins ago
Grievances & Appeals Lead
Humana
Jefferson City, MO
+ 7+ years in healthcare operations, compliance, process improvement, project management or related field

CareFirst

Senior Embedded Compliance Analyst - (Remote)

Baltimore, MD, United States

Salary Range: $70,200 - $139,425

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Job details

Pay: Salary Range: $70,200 - $139,425
Education: Bachelor’s degree
Experience: Experience: 5 years experience in health insurance industry, managed care and government programs, health insurance compliance programs, or related fields.
Posting language: English
Posted: Nov 4, 2026

Original job description

Resp & Qualifications

PURPOSE:

The Senior Embedded Compliance Analyst will support Corporate Compliance and its defined Compliance Program by performing compliance activities for Medicare Advantage. This position involves ensuring implementation and maintenance of the annual Compliance Workplan for Medicare Advantage while providing review and analysis of regulatory rules / guidelines, monitoring the organization's compliance performance, tracking Key Performance Indicators (KPIs)/Key Risk Indicators (KRIs), and supporting Program Integrity and Fraud, Waste, and Abuse (FWA) efforts. The Analyst will also help to monitor corrective action plans, established to address identified compliance issues, and perform post-evaluation procedures for compliance implementation and remediation activities.

ESSENTIAL FUNCTIONS:

Monitors compliance performance based on a Compliance Risk Assessment to provide compliance oversight for MEDICARE ADVANTAGE .Review, analyze, and distribute regulatory rules / guidelines / contractual requirements to educate impacted CareFirst business areas and delegated entities. Identify and track required actions as the result of regulatory rules / guidelines / contractual requirements. Track and assess Key Performance and Key Risk Indicators (KPI / KRIs).Identify compliance risks by gathering, reviewing, and analyzing organizational data for downward trends or instances of non-compliance or potential non-compliance.
Collaborate with business owners within MEDICARE ADVANTAGE to establish and monitor action plans to address remediation of compliance risks.Help ensure that a root cause analysis is performed to address underlying issues when an action plan is needed. Follow up with stakeholders to help ensure remediation efforts are on track, successful, and validate that action plans have been implemented correctly. Regularly monitor CAP implementation and communicate and report risks associated with identified control deficiencies to stakeholders. Provide reporting to the Compliance leadership, documenting CAP results and escalating risks and issues related to identification, implementation, and remediation.
Assist with the performance of post implementation procedures to validate performance of compliance requirements resulting from mandates, regulatory and contractual changes, systems, or partner implementations for MEDICARE ADVANTAGE .
Perform investigations, research, and due diligence to address compliance incidents, events, research, inquiries, and concerns from leadership for MEDICARE ADVANTAGE . Perform assessments to identify compliance risks preceding or in parallel to compliance incidents, events, company initiatives, Provide professionally written and audit-appropriate responses to the originating party, ensuring questions are answered and customer needs are effectively served within designated time frames while respecting the privacy needs of members.
Collaborate with Corporate Ethics & Compliance on Code of Conduct and Third-Party Code of Conduct to ensure compliance.Support and drive the continued to maturity of CareFirst compliance through on-going education, development of compliance tools, compliance initiatives, and collaboration with other compliance risk functions (e.g., Internal Audit, Executive Inquiry, Privacy) to respond to compliance incidents, gaps, and identified risks. Supports the development, implementation, and maintenance of written policies and procedures. for MEDICARE ADVANTAGE . Collaborate and contribute to standards of conduct.

QUALIFICATIONS:

Education Level: Bachelor's Degree in Business Administration, Healthcare Compliance or 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.

Licenses/Certifications Preferred:

CHC - Certified Healthcare Compliance or
CRCMP - Certified Risk And Compliance Professional or
Lean Six Sigma Certification-IASSC or
Certified Regulation Analyst or
Certified Compliance & Ethics Professional (CCEP)

Experience: 5 years experience in health insurance industry, managed care and government programs, health insurance compliance programs, or related fields.

Preferred Qualifications:

Healthcare Compliance certification(s).
Experience in CMS programs (Medicare or Medicaid, project management, business process analysis, workflow, and task analysis.
Process Improvement Systems training in Six Sigma, Lean, or other Business Process Improvement tools.

Knowledge, Skills and Abilities (KSAs)

Excellent interpersonal skills with ability to build consensus and agreement and bring resolution to contentious issues and entrenched interests.
Ability to present and discuss regulatory compliance goals in a way that establishes rapport, persuades others, and gains commitment.
Ability to research complex issues, interpret regulations and regulatory rules/guidance, and exhibit sound judgment in determining a recommendation or solution to a problem.
Word, Advanced Excel and database management and related software applications.
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.

Travel Requirements

Estimate Amount: 5% Travel to CareFirst locations or training may be necessary.

Salary Range: $70,200 - $139,425

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).

Department

Medicare Compliance Office

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

REQNUMBER: 22745

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