Resp & Qualifications PURPOSE: Defines, designs and develops system requirements. Performs trade-off analysis of performance, life-cycle cost, risk, producibility, and other system or program requirements. Assesses architecture and current hardware limitations, defines and designs system specifications, and evaluates input/output processes and working parameters for hardware/software compatibility. Coordinates design of subsystems and integration of total system. Defines system support requirements to include monitoring, capacity, staffing and patching/updating. Analyzes and resolves program support deficiencies. Conducts independent technical investigations in systems design.
ESSENTIAL FUNCTIONS: - Installs, tunes, upgrades, troubleshoots, and maintains all computer systems relevant to the supported applications including all necessary tasks to perform operating system administration, user account management, disaster recovery strategy and networking configuration.
- Develop and implement techniques to prevent system problems, troubleshoots incidents to recover services, and support the root cause analysis
- Evaluates new systems by performing in-depth tests, including end-user reviews. Researches software and related products to support recommendations and purchasing. Determines systems integration issues by evaluating components; developing and completing performance tests; analyzing test data; studying project requirements; analyzing user and potential user input; evaluating similar and related products and systems. Develop system automation and system integration of business processes.
- Improves engineering job knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; benchmarking state-of-the-art practices; participating in professional societies.
- Acts as a mentor for junior and senior team members.
SUPERVISORY RESPONSIBILITY: Leads a team utilizing a matrix management system.
QUALIFICATIONS: Education Level: Bachelor's Degree in Information Technology or Computer Science 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 - ITIL Foundations v3 within 180 Days Preferred
Experience: 8 years proven success overseeing the design, development, and implementation of software systems and applications.
Preferred Qualifications:
- 8+ years of experience supporting, administering, engineering, or implementing the Facets platform in a healthcare payer environment.
- 8+ years of experience with health insurance claims processing, including claims lifecycle, adjudication, benefits configuration, provider servicing, membership, and production support.
- Experience troubleshooting and resolving complex claims processing issues, system integrations, and production incidents impacting claims operations.
- Experience leading large-scale system implementations, upgrades, integrations, or transformation initiatives supporting healthcare claims platforms.
- Experience collaborating with business operations teams including Claims, Enrollment, Provider Services, Customer Service, and Configuration teams.
- Experience with healthcare EDI transactions, claims workflows, and related integrations is preferred.
- Experience with Blue Cross Blue Shield Inter-Plan Processing (IPP) is preferred.
Knowledge, Skills and Abilities (KSAs) - Knowledge of programming languages and web based technologies.
- Proficient in Microsoft Office applications.
- Ability to collaborate to solve technical problems across teams.
- Excellent communication skills both written and verbal.
- 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: $115,128 - $228,657
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).
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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