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Sr Plan Mgr Ops

Employment type: 
Full time
Remote Position: 
Required degree level: 

Please note, this role would require 35-40% travel.

Key responsibility for building and maintaining critical BCBS Plan/Client relationships with management staff responsible for operational performance of the Federal Employee Program (FEP). Plays a key role in providing strategic guidance, solving complex business problems and drive organizational efficiencies to improve Plan/Client operational performance. Serves as a trusted advisor to Plan/Client, providing insights and recommendations to Plans that drives to strengthen alignment with FEP strategic business objectives and goals. Influences and directs Plans/Clients to improve operational excellence and achieve critical business outcomes that positively impact Federal Employee Member satisfaction and overall Program performance.

Collect, analyze and interpret client/Plan performance data to provide innovative and data-driven solutions, unique to client/Plan needs. Plans and executes Plan Training Townhalls/Conferences that promote comprehensive understanding and knowledge of the Federal Employee Program and fosters government contracting compliance.

Monitors and assess impacts of large-scale Program-wide projects to unique Plan/Client needs. Collaborate with Plan/Client leadership to understand business goals and develop annual business plans that support their Plan/Client administrative costs budget proposals and maximize operations performance. Acts as a resource for Plan Leadership and provides guidance when needed.

Primary Job Functions

Influences and manages Plans relationships:

  • Drive 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 effect 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 customize business strategies for that drive operational excellence and costs efficiencies and that are aligned with the Program strategy and objectives
  • Continuously monitor Plans' performance to proactively resolve issues before impacting their performance

Timely resolution of Plan questions and issues:

  • Accountable for ensuing timely and accurate resolution of Plan questions and issues relative to operations performance and contract administration
  • Partners and collaborates with other FEPDO business units - Program Integrity, Individual Care Management, Provider Network Management as well as the FEP Service Benefit Plan Operations Center to resolve Plan specific and global issues/problems impacting all Plans relative to the administration of FEP as defined by the OPM contract

OPM/CPR audit responsibilities:

  • Provides direction and support to Plans to reduce Claims Audit Finding identified in OPM and/or CPR audits
  • Consults with Plans on implementing process improvements to resolve and minimize recurring OPM and CPR claims audit findings and reduce program risks relative to uncollected funds for benefits overpayments
  • Collaborates with Program Assurance to coordinate activities to timely resolve claims 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 annual Plan Operations Conference that provides venue for all Plans to meet with the FEPDO to exchange information, provide directional guidance, and addresses national issues in the contract administration of FEP
  • Leads and manages Operations Technical Advisory Group (OTAG) cross-functional Plan advisory group that is accountable for providing the FEPDO with recommendation and/or feedback on FEP claims/customer service and care management initiatives and policies
  • Acts as lead accountable for planning and executing the Plan Training Seminars that provides overview and directions to Plans' new management 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, Experience, and Certification:
Required: Bachelor's degree in business or a related discipline, or equivalent years of related experience


Required Experience
5+ years' work experience, within 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 in FEP leadership, in operations, with demonstrated outstanding performance

Knowledge, Skills, and Abilities

  • 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.

Other Responsibilities:

Revenue/Budget Responsibility: No

People Management: No

Travel Requirements: 35-40%

Work is generally performed in an office or remote setting; sedentary work (exerting up to 10 lbs. of force occasionally and involving sitting most of the time with
occasional standing and walking)

People Management



Make an impact on healthcare in America. A career with Blue Cross Blue Shield Association allows you to be part of the foundation that supports the 35 Blue Cross and Blue Shield companies nationwide, while protecting and strengthening the Blue Cross Blue Shield brand. Our work is helping provide greater access to cost-effective healthcare, improve the health of America and build stronger communities. With a commitment to diversity, equity and inclusion, we celebrate different cultures, languages, backgrounds and experiences while striving to advance health equity, and we want you to join Team BCBSA.

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