Jobs in the United States

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Added 8 mins ago
MDSO Deputy Sheriff Trainee
Miami-Dade County
FL
…hire date; AND High School diploma or equivalent AND have an Associate's Degree or sixty (60) college credits (Foreign school diploma evaluation may be required); OR Have two (2) years of…
Added 22 mins ago
Seasonal Retail Support Lead
Five Below Inc
Burnsville, MN
…Way, which is our values and behaviors that each and every associate believes…
Added 22 mins ago
Seasonal Retail Support Lead
Five Below Inc
Mankato, MN
…Way, which is our values and behaviors that each and every associate believes…
Added 23 mins ago
SALES ASSOCIATE PART- TIME w/BENEFITS (LADIES, COSMETICS & INTIMATES)
Navy Exchange Services (NEX)
PEARL HARBOR, HI
Title: SALES ASSOCIATE PART- TIME w/BENEFITS (LADIES, COSMETICS & INTIMATES) Location: United States-Hawaii-Pearl Harbor Job Number: 260003BJ Build a meaningful career as a Full-Time…
Added 28 mins ago
Parts Person, AM, Garage - Orlando
Publix Super Markets, Inc.
Orlando, FL
be able to multi-task and work independently with little or no supervision
Added 29 mins ago
SO
Supervising Accounts Examiner
State of Connecticut
Hartford, CT
- $105,612 to $137,277 USD / year
Added 29 mins ago
SO
Fiscal/Administrative Assistant
State of Connecticut
Hartford, CT
- $69,320 to $88,204 USD / year
Assisting Fiscal Administrative Officers and Associate Accountants with purchasing, physical inventory, telecommunication system administration, and contracts administration
Added 34 mins ago
Production Associate
Inteplast Group
Perrysburg, OH
Good organizational skills with the ability to prioritize and multi-task
Added 44 mins ago
A
Poolside | Attendant | Part-Time
AccorHotel
Wailea-Makena, HI
- $23.04 USD / hour
- Part-time
Must be able to multi-task and be detail-oriented in a fast paced, high volume environment.
Added 45 mins ago
BP
Veterinary Assistant
Banfield Pet Hospital
Ellicott City, MD
- $17.3 to $22.11 USD / hour
If you are a current associate, you will need to apply through our internal career site. Please log into Workday and click on the Jobs Hub app or search for Browse Jobs.
Added 45 mins ago
BD
Seasonal Internet Fulfillment Associate
Boscov's Department Store, LLC
Westminster, MD
- $15.5 USD / hour
Boscov’s Seasonal Internet Fulfillment Associate
Added 46 mins ago
Management Analyst SME
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Bethesda, MD
…Masters degree with 10+ years of prior relevant experience OR Associate's degree with 15+ years of prior relevant experience OR HS Degree with 18+ years of prior relevant…
Added 46 mins ago
Engineer / Principal Engineer Manufacturing
Northrop Grumman
Baltimore, MD
The chosen candidate must have excellent verbal and written communication skills; be able to multi-task in a fast-paced, dynamic, and high visibility environment; and work well as part of a…
Added 47 mins ago
DR
Workplace Coordinator
Dyna Robotics
Redwood City, CA
- $40 to $45 USD / hour
…receive, inspect, and store incoming parts. Support the Inventory Associate with cycle counts and stockroom organization, keeping quantities accurate and parts kitted for builds, repairs,…
Added 48 mins ago
Deposit Operations Associate/Specialist
GPAC
Watertown, CT
A local Connecticut bank is confidentially looking to add another member to their banking family. They are seeking a Deposit Operations Associate/Specialist.
Added 48 mins ago
Deposit Operations Associate/Specialist
GPAC
Ross Township, PA
A local community bank is confidentially looking to add another member to their banking family. They are seeking a Deposit Operations Associate/Specialist.
Added 1 hour ago
NE
SUPERVISORY SALES ASSOCIATE / FULL TIME
Navy Exchange Services (NEX)
KITTERY, ME
- Full-time
Added 1 hour ago
Communications Specialist
Sweetser
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Fulfill job functions by participating as an active member in all training as assigned, and participating on organization task forces.
Added 1 hour ago
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Basking Ridge, NJ
Demonstrates competency in performing job task and in operating equipment on an annual basis
Added 1 hour ago
Environmental Associate
Yale New Haven Health
NEW HAVEN, CT
…equipment and lift up to 40 pounds as are required for the specific task available. All duties require some pushing, pulling, bending, and standing. Consistent use of proper body mechanics.…
Added 1 hour ago
RC
Flooring Sales Associate
R C Willey Home Furnishings
Reno, NV
- $60,000 to $80,000 USD / year
Added 1 hour ago
Patient Access Representative - Scheduling
Beth Israel Lahey Health
Exeter, NH
Education: High school degree or equivalent. Associate’s degree preferred.
Added 1 hour ago
Manufacturing Technician 3
ManpowerGroup
Londonderry, NH
Associate’s Degree or certificate in a technical discipline in electronics, mechanical, software or related technologies
Added 1 hour ago
CT
Support Associate IV- Second Shift
CGI Technologies and Solutions, Inc.
Portsmouth, NH
- $26.11 USD / hour
The Support Associate Level IV provides support to the Government staff and performs accounting functions, prepares letters, reports and specialized correspondence. Anticipated tasks…
Added 1 hour ago
Sales Associate
Petco Animal Supplies Stores, Inc.
El Cajon, CA
As a Sales Associate, you are at the heart of the Pet Care Center experience. You help pet parents find the right products and solutions for their pets while creating a welcoming, safe, and…

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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