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

Certifications
N/A

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

No

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