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Job Details

Sr. Plan Manager Operations

Company name
Blue Cross and Blue Shield Association

Washington, DC, United States

Employment Type

Manager, Operations, Healthcare, Insurance

Posted on
Mar 03, 2021

Valid Through
Jun 16, 2021

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Key responsibility for building and maintaining critical BCBS Plan relationships with management staff responsible for FEP operational performance. Provides intelligence and direction to Plans that drives alignment with FEPs strategic business objectives and goals. Influences and directs Plans' management staff to drive operational excellence and achieve critical business outcomes that positively impact member satisfaction and Program performance. Plans and executes Plan Training Seminars/Conferences that promotes comprehensive understanding and knowledge of FEP, fostering government contract compliance. Responsible for overseeing Plan efforts to develop and execute business plans that support their administrative costs budget proposals and maximize operations performance. Acts as the lead accountable for developing and executing Plan Training Seminars that provides holistic understanding and knowledge of FEP. Acts as resource and trainer for the Plan Managers, Operations and provides guidance when needed.
Responsibilities include but are not limited to:

Influences and manages Plans relationships to 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 to affect change and consistently achieve excellent performance scores on PIP Service Profile and member satisfaction.
Evaluates and analyzes Plans\u2019 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.
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 \u2013 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.
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.
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.

Required Basic Qualifications:

4 years\u2019 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
Exceptional negotiating skills
4-year college degree

Preferred Basic Qualifications:

1 or more years\u2019 experience working as the Plan Manager, Operations position with demonstrated outstanding performance
Superior relationship management skills with demonstrated ability to maintain strong relationships with key with business partners
Demonstrated comprehensive understanding of BCBS Plans\u2019 FEP operations
Exceptional negotiating skills with the ability to influence Plans\u2019 behavior to drive business objectives
Excellent communication and presentation skills

Equal Opportunity Employer
Blue Cross Blue Shield Association is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, national origin, age, gender identity, disability, veteran status, genetic information or any other legally protected characteristics

Company info

Blue Cross and Blue Shield Association
Website :

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