The hiring range for this role is:
107,666.00 - 150,995.00This is the lowest to highest salary we, in good faith, believe we would pay for this role at the time of this posting. We may ultimately pay more or less than the hiring range and this hiring range may also be modified in the future. A candidate’s position within the hiring range may be based on several factors including, but not limited to, specific competencies, relevant education, qualifications, certifications, relevant experience, skills, seniority, performance, shift, travel requirements, and business or organizational needs. This job is also eligible for annual bonus incentive pay.
We offer a comprehensive package of benefits including paid time off, 11 holidays, medical/dental/vision insurance, generous 401(k) matching, lifestyle spending account and many other benefits to eligible employees.
Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.
Influences and manages Plans relationships:
Drives operational excellence that aligns with FEP Strategy, achieving business success measures and driving Plan satisfaction.
Provides guidance and direction to Plans to implement performance improvements and program initiatives to affect change and consistently achieve excellent performance scores on PIP and member satisfaction.
Evaluates and analyzes Plans’ internal business processes, procedures and policies to identify opportunities for process and/or performance improvements that drives operational excellence and efficient business processes that have favorable impact on the Plans' efforts to manage FEP administrative costs.
Develops and executes Plan business strategies that are aligned with the Program strategy and objectives that drive operational excellence and cost efficiencies.
Continuously monitor Plans' performance to proactively resolve issues before impacting their performance.
Accountable for ensuring timely and accurate resolution of Plan questions and issues relative to operational performance and contract administration.
Partners and collaborates with other BCBSA/FEP business units, including Program Integrity, Care Management, Provider Network Management, FEP Operations Center, etc., to resolve Plan specific and global issues related to the administration of FEP as defined by the OPM contract.
OPM/CPR audit responsibilities:
Provides direction and support to Plans to reduce operational audit findings identified in OPM and/or CPR audits.
Consults with Plans to implement process improvements to resolve and minimize recurring OPM and CPR audit findings and reduce Program risks relative to uncollected funds for benefits overpayments.
Collaborates with Program Assurance to coordinate activities to timely resolve audit issues affecting the Plans and financial exposure to the Program.
Annual Conference accountabilities/Project Management
Acts as business leads accountable for planning and executing the conferences and trainings that provide a venue for all Plans to meet with the BCBSA/FEP to exchange information, provide directional guidance, and address national issues in the contract administration of FEP.
Leads and facilitates the Operations Advisory Workgroup (OAWG), which is a cross-functional Plan advisory group accountable for providing the BCBSA/FEP with recommendations and feedback on claims, customer service, and care management initiatives and policies.
Leads, plans, and executes Plan training that provides education and direction to Plans’ new management and staff responsible for FEP business functions.
Conducts and leads FEP Core Business Initiatives critical to the operations of the Program. (SC Plan and FEPOC Business Portability, FEP Business Contingency).
Provides business expertise on cross-functional projects/committees to provide guidance on issues impacting local Plans and to address/mitigate any potential adverse impact on Plans and the Program.
Education
Bachelor’s degree in business or a related discipline, or equivalent years of related experience
Certifications
Experience
5+ years’ work experience, with in health insurance operations.
Advance experience and understanding of health plans' operational business procedures/processes.
Extensive experience with account/relationship management with the ability to maintain strong business relationships.
2 or more years’ experience working as FEP Plan leadership, in Operations with demonstrated outstanding performance.
Skills
Superior relationship management skills with demonstrated ability to maintain strong relationships with key with business partners.
Demonstrated comprehensive understanding of BCBS Plans’ FEP operations.
Exceptional negotiating skills with the ability to influence Client/Plans’ behavior to drive business objectives.
Advance analytical and conceptual skills with ability to analyze and resolve problems/issues timely and accurately.
Advance negotiation and strategic thinking skills with the ability to influence Client/Plans’ behavior to drive Program success.
Analytical skills with ability to identify and prioritize critical business issues.
Exceptional presentation skills and experience presenting to various size groups.
Excellent communication skills, both oral and written.
People Management
No
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