Job Description

What You’ll Do

• Proactively identify, evaluate and lead the implementation of healthcare redesign, provider reimbursement and partnership strategies to meet BCBSNC’s growth objectives, as well as manage healthcare costs while improving outcomes and the healthcare experience for our members.
• Support and manage development efforts related to the enhancement and maintenance of our current products and market offer components.
• Lead critical activities such as strategic planning, highly complex quantitative/qualitative analysis and thought leadership at a departmental and enterprise level. 
• Present information such as strategic concepts, planning data, medical expense/reimbursement rates, provider performance metrics and impact assessments to both internal and external audiences at all levels, including senior-level leadership.
• Organize, optimize and communicate progress towards the completion of overall work portfolio.
• Collaborate with and support other departments across the enterprise on both common initiatives and unique ventures, acting as a subject matter expert for healthcare delivery transformation and/or healthcare reimbursement and strategy.
• Identify, analyze and monitor industry, regulatory, technology and market-based trends that affect divisional operations, provider reimbursement, medical expense strategy and overall payer-provider dynamics.
• Utilizes extensive expertise to identify and drive operational improvements with new analysis/reporting capabilities, project management techniques and/or consulting/engagement approaches.
• Serve as a mentor and coach to more junior team members regarding various skills and approaches and may oversee work of other staff members as needed

What You Bring

• Bachelor's degree or advanced degree
• 8+ years of experience in a related field
• In lieu of degree 10+ years of experience in related field.

Bonus Point (Preferred Qualifications)

• Risk Adjustment experience
• Experience with Medicare or ACA
• Experience with Data Analytic Tools (SQL, R, SAS, Python)

Salary Range

At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets,  licensure and certifications and other business and organizational needs. Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs. 

*Based on annual corporate goal achievement and individual performance.
 

Skills

_____________________________________________________________________

JOB ALERT FRAUD: We have become aware of scams from individuals, organizations, and internet sites claiming to represent Blue Cross and Blue Shield of North Carolina in recruitment activities in return for disclosing financial information. Our hiring process does not include text-based conversations or interviews and never requires payment or fees from job applicants. All our career opportunities are published on https://bcbsnc.wd5.myworkdayjobs.com/en-US/BCBSNC. If you have already provided your personal information that you suspect is fraudulent activity, please report it to your local authorities. Any fraudulent activity should be reported to: [email protected].