CareFirst Careers

Process Improvement Specialist

Resp & Qualifications

This position, under the direction of the Manager of Executive Inquiry and Business Process Improvement, is responsible for managing the quality and process improvement activities in coordination with various stakeholders across the organization including but not limited to Strategic Business Units, Operational Functional Areas, Public Policy, Compliance and Legal.  The incumbent’s accountabilities include, but are not limited to, the following:

1. Leads Business Process Improvement Initiatives/Project Teams: 
Improve existing processes through the identification, support, and execution of projects. This position will support Six Sigma, Lean or other types of business process improvement efforts focused on improving operational effectiveness.

  • Work closely with functional leaders to identify, implement and execute key projects from inception to completion.
  • Dissect processes and information to construct clear findings resulting in improvement recommendations, such as designing changes to a functional unit’s workflow and influencing others to buy in on those changes.
  • Use project management and Six Sigma/DMAIC, Lean or other business process improvement methodologies to deliver operational improvements in specific time frames, across operational areas (Claims, Enrollment, Sales Service, etc.)
    • Manage all phases of the project life cycle process, which include monitoring progress, serving as resource to divisional management regarding the project, preparing documentation for appropriate management.
    • Manage the project work (task, sequencing, milestones, risk, and contingencies) to ensure that the project is launched on time and within time constraints. 
    • Analyze processes, audit results and data trends, recommend action and assist with implementation of strategies that drive continual improvement.
    • Create measurement strategy
  • Identify critical technical/process issues and data driven opportunities to develop and implement corrective actions, as necessary. 
  • Analyze processes, audit results and data trends, recommend action and assist with implementation of strategies that drive continual improvement.
  • Identify critical technical/process issues and data driven opportunities to develop and implement corrective actions, as necessary. 
  • Assist with the research of internal and external best practices and remain current in new quality tools, techniques and practices.
  • Coordinate, facilitate, document, and report all aspects of assigned project(s) utilizing project plans and work plans for tracking assigned workload.
  • Develop executive level and front-line level presentations.
  • Create measurement strategies for each project and process improvement initiative.

2. Collects, Organizes, Analyzes Data and Report Delivery: 
Diagnose issues, identify root causes, and drive change management initiatives.

  • Investigate and analyze feasibility of low to complex enhancements, and processes. Analyze, define and interpret business needs and issues by gathering, analyzing, documenting and validating the business area processes.
  • Participate in requirements analysis and verification sessions for complex projects and may lead requirements analysis and verification sessions for less complex projects.
  • Participate in the tracking and management of open issues and assists in planning for resolution of complex projects.
  • Responsible for overseeing the maintenance and updating of weekly, monthly, quarterly and annual reporting.
  • Delivery of key statistical trend analyses to leadership with recommendations as to process improvements, forecasts for peak volumes and elimination of unnecessary rework.
  • Participates in the development, tracking, analysis and reporting.
  • Maintain communications with counterparts to adopt best practices.

3. Support Regulatory Compliance:

  • Maintain current knowledge of healthcare practices and regulatory mandates as they relate to inform and assure successful implementation.
  • Acts as Subject Matter Expert and liaison.
  • Collaborate with Manager and monitors compliance with regulatory requirements.
  • Collaborate with project and functional support teams on implementation of change initiatives. Partner with Compliance and Legal for interpretation of policies, adapting standards as necessary.
  • Actively participate with the Manager, Compliance and operations to design, collect, analyze results and suggest improvement strategies.

4. Quality Improvement Support: 

  • Lead, coordinate and facilitate QI-related committees.
  • Confer with Leadership, as applicable, to establish agenda according to work plan
  • Prepare and distribute meeting materials and document accurate, contemporaneous meeting minutes
  • Complete timely follow-up on action items.
  • Deliver oral and written quality improvement related reports for committees as needed for the responsible functional area

5. Administrative Support:
Based on business needs and experience, incumbent may be assigned additional responsibilities as deemed necessary. These may include, but is not limited to, the following:

  • Respond to customer submitted CEO and Executive Leadership complaints; respond to Exchange inquiries and communicate processes to the Exchanges and Legal.
  • Create Business Process Improvement Tools.
  • Using knowledge and judgment develop and/or review and revise performance standards, policies and procedures.
  • Participate in the development, revision and review of other materials, such as member standard operating procedures and development of workflows.


Required Education/Skills/Abilities:

  • A minimum of a Bachelor’s Degree is required. In lieu of a degree, as additional 4 years of experience is required.
  • Minimum of 5 years of process improvement experience is required.
  • Ability to interpret national accreditation standards and federal/state certification requirements.
  • Strong analytical and project management skills and overall business acumen.
  • Critical thinking and sound judgment.
  • Strong verbal and written communication skills; ability to write detailed reports for various audiences.
  • Strict attention to detail.
  •  Ability to positively interface with internal staff and external providers.
  • Excellent technical competency, including at minimum Microsoft software (Word, Excel, Access, Powerpoint, Project, Sharepoint) and Adobe Acrobat with proven ability to quickly learn new end user technologies. 
  • Ability to effectively develop and implement effective quality improvement strategies in a dynamic fast paced healthcare environment.
  • Demonstrated experience in developing policies, Standard Operating Procedures, training materials, and committee meeting minutes.
  • Must be able to effectively work in a fast-paced environment with frequently changing priorities, deadlines, and workloads that can be variable for long periods of time. 
  • 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.


  • Master’s degree in business or health related field
  • Certification in Business Process Management/Engineering
  • Certification in Six Sigma, Lean, or other Business Process Improvement tools



Department: CD EI and BPI

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.

Hire Range Disclaimer

Actual salary will be based on relevant job experience and work history.

Where To Apply

Please visit our website to apply:

Closing Date

Please apply before: 9/29/2018

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.

The physical demands described below are representative of those that must be met by an associate to perform the essential duties and responsibilities of the position successfully.  Requirements may be modified to accommodate individuals with disabilities.

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 employee must frequently talk and hear.  Weights of up to 25 pounds are occasionally lifted.  Occasional driving or travel is required.

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship

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