Job Description Summary

Develops, implements, and operates programs to support Blue Cross Blue Shield Plan competitiveness in government programs, with a focus on senior markets. Provides leadership and subject matter expertise for team that develops and operates inter-Plan products and services for Blue Plans. A successful candidate will develop and leverage relationships with Plan and external partners, refine existing programs focused on gap closure and medical record retrieval, enhance operational and executive reporting and to anticipate opportunities and proactively implement solutions. Manage relevant inter-Plan workgroups and partner with other areas of Inter-Plan Programs to:

1) Assess Plan business needs and impacts of proposed solutions and
2) Gain consensus for proposed Inter-Plan program solutions and enhancements. Impacts all Licensees and BCBSA organizations. Extensive interaction with Plan-based workgroups, governance committees and Plan staff in multi-disciplines, operations, technology, national account marketing, and provider relations.

Responsibilities include but are not limited to:

• Government Markets Solutions - Lead development, implementation and operations of business strategies, programs and initiatives to support national delivery of Plan's products and services in government markets, including Medicare and Medicaid. Leverage and enhance BCBSA, Plan and Systemwide reporting to improve operations. Anticipate changes in market and develop operational responses. Responsible for multi-year and annual Business Plans, including strategic initiatives roadmap, corresponding technology support, and collaborating with appropriate business/technology partners to develop capabilities to meet market needs. Lead and guide teams in the development/enhancement and implementation of new and existing national products. Partner with internal stakeholders (e.g., Policy and Representation, Strategic Services, Clinical Affairs, FEP) to shape policy and legislative direction at both the state and federal level to represent BCBS priorities. Implement communication strategies to effectively share the value of initiatives and solutions throughout BCBSA and Blue Plans. Develop solutions to ensure national delivery operations comply with federal and state regulations. Implement and operate a continuous improvement mindset to ensure effective Plan support and operations.
  
• Management - Recruits, selects, develops and motivates team providing them with appropriate training, assignments and opportunities to assume greater responsibility and to assure successful delivery of programs and initiatives. Promotes effective management across matrix organization using collaborative processes and effective and timely decision making. Manages department budget and resources to assure adherence to corporate and regulatory policies and procedures.
  

Required Education, Certifications and Experience

• Bachelor's degree in business or healthcare or equivalent experience
• Ten+ years of progressive health insurance experience in combination of both business development and operations
• Minimum eight years prior experience managing staff and budgets
• Minimum five years experience with the development and implementation of major government programs initiatives in support of large account business
• Demonstrated strategic thinking and approach to problem solving
• Ability to develop key business partnerships both internal and external
• Effective organization, presentation, negotiation and communications skills (oral and written)
• Extensive knowledge of Health Care industry and Health insurance systems and processes, specifically Medicare Advantage

Preferred Education, Certifications and Experience

• Master's degree in health care administration.
• Five years of progressive Blue Cross and BlueShield experience
• Five years of progressive experience in Medicare Advantage operations or product design

People Management- Yes