Sr Plan Manager Ops

The hiring range for this role is:

107,666.00 - 150,995.00

Key responsibility for building and maintaining critical BCBS Plan/Client relationships with management staff responsible for operational performance of the Federal Employee Program (FEP). Plays a key role in providing strategic guidance, solving complex business problems and drive organizational efficiencies to improve Plan/Client operational performance. Serves as a trusted advisor to Plan/Client, providing insights and recommendations to Plans that drives to strengthen alignment with FEP strategic business objectives and goals. Influences and directs Plans/Clients to improve operational excellence and achieve critical business outcomes that positively impact Federal Employee Member satisfaction and overall Program performance.
Collect, analyze and interpret client/Plan performance data to provide innovative and data-driven solutions, unique to client/Plan needs. Plans and executes Plan Training Townhalls/Conferences that promotes comprehensive understanding and knowledge of the Federal Employee Program and fosters government contracting compliance.
Monitors and assess impacts of large-scale Program-wide projects to unique Plan/Client needs. Collaborate with Plan/Client leadership to understand business goals and develop annual business plans that support their Plan/Client administrative costs budget proposals and maximize operations performance. Acts as a resource for Plan Leadership and provides guidance when needed.

Influences and manages Plans relationships:

• Drives 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 affect 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 business strategies that are aligned with the Program strategy and objectives that drive operational excellence and cost efficiencies.

• Continuously monitor Plans' performance to proactively resolve issues before impacting their performance.

• Timely resolution of Plan questions and issues:

• Accountable for ensuring timely and accurate resolution of Plan questions and issues relative to operational performance and contract administration.

• Partners and collaborates with other BCBSA/FEP business units, including Program Integrity, Care Management, Provider Network Management, FEP Operations Center, etc., to resolve Plan specific and global issues related to the administration of FEP as defined by the OPM contract.

OPM/CPR audit responsibilities:

• Provides direction and support to Plans to reduce operational audit findings identified in OPM and/or CPR audits.

• Consults with Plans to implement process improvements to resolve and minimize recurring OPM and CPR audit findings and reduce Program risks relative to uncollected funds for benefits overpayments.

• Collaborates with Program Assurance to coordinate activities to timely resolve 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 conferences and trainings that provide a venue for all Plans to meet with the BCBSA/FEP to exchange information, provide directional guidance, and address national issues in the contract administration of FEP.

• Leads and facilitates the Operations Advisory Workgroup (OAWG), which is a cross-functional Plan advisory group accountable for providing the BCBSA/FEP with recommendations and feedback on claims, customer service, and care management initiatives and policies.

• Leads, plans, and executes Plan training that provides education and direction to Plans’ new management and staff 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
Bachelor’s degree in business or a related discipline, or equivalent years of related experience
 

Certifications
Experience

• 5+ years’ 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.

• 2 or more years’ experience working as FEP Plan leadership, in Operations with demonstrated outstanding performance.

Skills

• 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.

People Management
No

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