- Responsible for the relationship and contractual management with multiple different platforms across our Commercial and Coupe Health membership. Entities may include but are not limited to Blue Cross Blue Shield Alabama (BCBSAL), Independence Blue Cross (IBX), other Blue Partner Plans (BPP) and Third-Party Administrators (TPA) (such as UTIC and Amerihealth [AHA]). This role will lean heavily into the platform integration and operational strategies across each entity.
- Drives the strategy for benefits on BPP platforms: Establish and advocate for medical policy, prior authorization, and benefit administration rules (including preventative benefit alignment).
- Accountable for managing and communicating coverage or benefit updates, including partnering with internal teams (such as, medical management, InterPlan, sales and account management, sales operations, legal, etc.) and aligning with clients and BPP for all products offered at BCBSMN, including Coupe Health.
- Act as a centralized coordination point for engaging with BCBSAL, AHA and other BPP regarding policy interpretation and compliance. Ensure initiatives, strategy, and policymaking are aligned with the company strategy and business operations.
- Coordinate with medical product management across Blue Cross Blue Shield MN (BCBSMN) and BPPs to ensure; proper client benefit management and set-up, client renewals and account management. Guarantee consistency that BPP-based products are updated with the same cadence as BCBSMN fully insured (FI) products.
- Provides primary point of accountability for BCBSAL, IBX and other BPP interactions. Provides high-level guidance to internal team members facilitating strategic decision making to influence critical BPP issues, to promote internal alignment and consistency with external partners.
- Lead the implementation of New to Blue (NTB) clients for BCBSMN on BPPs platforms (such as UTIC, AHA, etc.) and support setup for BCBSMN renewals on partnering platforms.
- Accountable for BCBSMN's adherence to contractual and regulatory compliance requirements (Examples: NCQA, NQTL, etc).
- Create metrics and monitor performance with BPPs through KPIs and SLAs.
- Establish performance improvement plans for performance areas that drop below established acceptable thresholds.
- Partner with Client & Acct Operations and data teams to provide oversight and monitor data transmissions between BCBSMN and BPP teams to ensure appropriate and timely data exchanges.
- Works with BCBSMN internal audit team to ensure proper procedures are in place with Blue Partner Plans (BPP).
- Establish regularly agreed upon leadership meetings review performance and set forward strategies, and ensures BCBSMN's senior leaders are appropriately briefed on the status issues, resolution, etc.
- Collaborates with InterPlan, legal, and other key partners on Blue Cross Blue Shield Association (BCBSA) policy requirements and metrics.
- Primary point of contact for BCBSMN Commercial Markets team for issue resolution.
- Reviews, analyzes, and makes recommendations on actions for existing products (Blue Administrator, Coupe Health)
- Responsible for supporting the Product Lifecycle Management process to monitor product performance (clinical, financial, and operational) across all markets, as well as a competitive analysis research for benefits, market and regional data and trends.
- Bachelor's degree.
- Experience working with Blue Plans and/or Blue Plans Partners.
- Management experience
- Experience working in Health Insurance.
- Accepting this director level position at BCBSMN requires signing an Employee Confidentiality, Intellectual Property Assignment and Restrictive Covenants Agreement as a condition of employment.
- 7+ years of related professional experience, all relevant experience including work, education, transferable skills, and military experience will be considered.
- Executive presence and ability to work, facilitate and collaborate with internal and external partners at all levels including senior leadership.
- Advanced understanding of Blue System structure.
- Strong organizational and multi-tasking skills with an eye for prioritization.
- Proven knowledge and experience in developing, implementing, managing, and facilitating meetings.
- Demonstrate ability to partner with Business Owners on compliance issues, including the ability to navigate difficult conversations to ensure business operations are performed in compliance with contractual obligations.
- Strong interpersonal, communication, documentation, and problem-solving skills.
- Strong knowledge of health insurance industry issues, trends, practices, products, and rate setting.
- Excellent analytical skills and ability to accurately interpret sophisticated documents and policies.
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Director, Blue Partner Strategy - Eagan, United States - BlueCross BlueShield of Minnesota
Description
About Blue CrossBlue Cross and Blue Shield of Minnesota is one of the most recognized and trusted health care brands in the world with 2.5 million members. We're committed to reinventing health care to improve health for our members and the community. We hope you'll join us.
How Is this Role Important to Our Work?
This leadership role will establish and coordinate key relationships and foundational processes for Blue Cross Blue Shield MN (BCBSMN) with Blue Partner Plans (BPP) and Third-Party Administrators (TPA). The Dir of Blue Partner Strategy will own the relationship and act as a liaison for BCBSMN with BPPs and TPAs to represent the organization in accordance with contractual agreements. Drives strategies for benefits and medical policy on BPP platforms; serving as a voice for client needs, advocating for medical policy consistency that supports business growth and meet market demands. Ensures key BCBSMN and BPP strategic and operational issues are identified and addressed internally and externally.
A Day in the Life:
Nice to Have:
Required Skills and Experiences:
Blue Cross is an Equal Opportunity and Affirmative Action employer that values diversity. All qualified applicants will receive consideration for employment without regard to, and will not be discriminated against based on race, color, creed, religion, sex, national origin, genetic information, marital status, status with regard to public assistance, disability, age, veteran status, sexual orientation, gender identity, gender expression, or any other legally protected characteristic.
Reasonable Accommodation for Job Seekers with a Disability: If you require reasonable accommodation in completing this application, interviewing, completing any pre-employment testing, or otherwise participating in the employee selection process, please direct your inquiries to
All roles require a high school diploma (or equivalency) and legal authorization to work in the U.S.
Blue Cross and Blue Shield of Minnesota and Blue Plus are nonprofit independent licensees of the Blue Cross and Blue Shield Association.
Blue Cross and Blue Shield of Minnesota is an Equal Opportunity and Affirmative Action employer that values diversity. All qualified applicants will receive consideration for employment without regard to, and will not be discriminated against based on race, color, creed, religion, sex, national origin, genetic information, marital status, status with regard to public assistance, disability, age, veteran status, sexual orientation, gender identity, or any other legally protected characteristic.
