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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:
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.
Nice to Have:
Bachelor's degree.
Experience working with Blue Plans and/or Blue Plans Partners.
Management experience
Experience working in Health Insurance.
Required Skills and Experiences:
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.
Full Time
Insurance
$123k-158k (estimate)
04/09/2024
06/08/2024
bluecrossmn.com
SAINT PAUL, MN
3,000 - 7,500
1995
JUDITH LINDSTROM
$1B - $3B
Insurance
About Blue Cross Blue Cross and Blue Shield of Minnesota is a taxable, nonprofit organization with a mission to make a healthy difference in peoples lives. Chartered in 1933 as Minnesotas first health plan, weve promoted wider, more economical and timely availability of health services for the people of Minnesota for 80+ years. Blue Cross and Blue Shield of Minnesota is a nonprofit independent licensee of the Blue Cross and Blue Shield Association. Terms of Use All comments, visuals, videos and other type of material posted by fans on this site do not necessarily reflect the opinions or ideals... of Blue Cross and Blue Shield of Minnesota (Blue Cross), its employees or affiliates. THIS SITE SHOULD NOT BE USED TO CONTACT BLUE CROSS ABOUT ANY CLAIM, MEDICAL CONDITION, PRODUCT OR SERVICE OFFERED BY BLUE CROSS. Blue Cross (a) does not represent or warrant the accuracy of any statement, product or service claims made here, (b) is not responsible for any such content on this site, and (c) does not endorse any opinions expressed on this site. All materials and comments posted by users must comply with LinkedIns Terms of Use. Blue Cross does not monitor every posting on this site. Blue Cross expects, however, that users will not post any comments or material that falls into any of the following categories and may have removed any comments or materials that: Defame, abuse, harass, stalk, threaten or otherwise violate the legal rights (such as rights of privacy and publicity) of others. Publish, post, distribute or disseminate any defamatory, infringing, obscene, indecent, misleading or unlawful material or information.
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