This role manages all aspects of a large health insurance program. Leads all aspects of contracting and implementation with the vendor partner and Office of Personnel Management (Office of personnel management). Responsible for developing the strategic business objectives to advance the program. Leads the vendor partner and internal staff to develop and implement a work plan to ensure the strategic objectives are met. Manges all aspects of contract oversight for two contracts, the vendor partner and OPM. Leads all aspects of the annual benefit development. Leads and serves as the subject matter expert for program education including the daily relationships with all parties involved in the program, facilitating education materials, as well as attending and presenting at events throughout the year.
Why TeamBCBSA?
This is a highly exciting role because the person has the opportunity to truly own the entire dental operations from a program perspective. They won’t just be managing the day-to-day operations, but will also be shaping key areas like claims oversight, grievance and appeals, provider credentialing, customer service, and utilization management. It’s a unique opportunity to drive the overall health plan operations for dental and to have a real impact on how we serve our members.
- Manages all aspects of vendor contract oversight. Monitoring all aspects of the vendor contract are being adhered to including service level agreements, reporting requirements, processes, and internal controls. Oversees the inquiry response process to make sure questions/issues are resolved timely, accurately, and comprehensively. Assures that the vendors fully cooperate and comply with all aspects of audits (financial, control performance reviews, claims reviews, information technology, information security, and Office of Inspector General)
- Develops the strategic business objectives to increase enrollment and retain membership to be the market leader while maintaining profitability. This includes tasks such as the annual enrollment goals, annual profitability goals, leading strategy meetings internally and with the vendor partner, leading quarterly business reporting meetings, conducts industry research, and facilitates research surveys.
- Leads all aspects of the annual benefit development and implementation including development of benefit changes, coordinating actuarial premium development, brochure updates and clarifications, develops call letter response, manages OPM benefit negotiations, and oversees vendor implementation of changes.
- Leads and serves as the subject matter expert for program education. This includes being the primary program contact, as well as developing and maintaining the relationships with the vendor partner, OPM, the local BCBS Plans and internal BCBSA staff. Facilitating, providing content, and reviewing all program education items such as flyers, advertising materials, presentations, social media content, emails, newsletters and wellness articles.
- Leads the creation, content, updates, and navigation for the program website and mobile application. Recommends and oversees the creation and updates of program digital tools. Leads and participates in work groups, presents at meetings/conferences, attends community and open season events, conducts trainings (vendor, BCBSA and Plan staff), and represents the program at other meetings occurring throughout the year.
- Leads all contracting and contract implementation activities. This includes leading the Request for Proposal (RFP) process activities such as developing the request for proposal, analyzing applicable vendors, financial assessments, vendor selection, implementation of the selected vendor, contracting, and any contract modifications throughout the life of the contract. Additionally, leads the application renewal process with the Office of Personnel Management (OPM) including tasks such as application response, contracting, annual contract renewal and any contract modifications through the life of the contract. Note: this function is very heavy every seven years when the contracts are renewed but much lighter once contracts are implemented.
- Manages all aspects of OPM contract oversight. Ensures all aspects of the OPM contract are adhered to including but not limited to service level agreements, reporting requirements, and processes. Oversees the inquiry response process to make sure questions/issues are resolved timely, accurately, and comprehensively.
The posting range for this position is:
$103,677.00-$149,129.62
Qualifications:
Education
- Required Bachelor's Degree College Degree or equivalent work experience
Experience
- Required 5+ Years health insurance industry and/or health care knowledge and experience
Knowledge Skills and Abilities
- Knowledge and demonstrated skills in developing, planning, directing, and execution of strategic business plans.
- A proven record of measurable accomplishment in developing and administering strategic business plans
- Effective relationship skills with the ability to interact effectively and work collaboratively with internal and external staff, participate or take the lead in Plan visits, increasing awareness and understanding of BCBSA and the program value.
- Knowledge and demonstrated skills in contracting and contract oversight
- Ability to identity and quantify the appropriate metrics to determine strategic direction and success.
- Ability to translate technical and complicated information into member friendly communications.
- Knowledge and understanding of customer service processes
- Ability to ensure that complex computer systems are programmed to adjudicate claims correctly.
- Ability to work well under pressure, with demonstrated success at working under deadlines with tight time frames.
- Analytical and problem solving skills
- Organizational and leadership skills
- Decision making skills in complex situations
- Strategic thinking skills
- Outstanding written and verbal communications skills –in particular
- Solid writing skills with ability to craft comprehensive and persuasive communications
- Ability to create and deliver presentations to meet the need of the client (Plan, Agency, Member, OPM, etc.)
#LI-Hybrid
The posted salary range is the lowest to highest salary we, in good faith, believe we would pay for this role at the time of this posting. We may ultimately pay more or less than the hiring range andthis hiringrange may also be modified in the future. A candidate’s position within the hiring range may be based on several factors including, but not limited to, specific competencies, relevant education, qualifications, certifications, relevant experience, skills, seniority, performance, shift, travel requirements, and business or organizational needs. This job is also eligible for annual bonusincentivepay.
We offer a comprehensive package of benefits including paid time off, 11 holidays, medical/dental/vision insurance, generous 401(k) matching, lifestyle spending account and many other benefits to eligible employees.
Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.
