Inter-Plan Affairs & Compliance Lead

About Blue Cross

Blue Cross and Blue Shield of Minnesota is one of the most recognized and trusted health care brands in the world with 2.5 million members. We're committed to reinventing health care to improve health for our members and the community. We hope you'll join us.

How Is This Role Important to Our Work?

The Inter-Plan Affairs and Compliance Lead will serve as backup for the Inter-Plan Executive, a liaison for BCBSMN with the Blue Cross Blue Shield Association (BCBSA) and other Blue Plan Inter-Plan Executives (IPEs). The Inter-Plan Affairs and Compliance Lead is a business owner on key BCBSA mandates and projects.

This role will represent Blue Cross and Blue Shield of MN (BCBSMN) in key Blue System workgroups, committees and in other appropriate System-wide/Inter-Plan forums. Ensures BCBSMN's Plan compliance with all BCBS requirements (BCBS License Agreement, Membership Standards, Brand Regulations, Inter-Plan Programs and Medicare Advantage Policies); Assists with the development and execution of internal assessments of BCBSA strategies, programs, and policy recommendations and ensures appropriate integration within the enterprise. Ensures key BCBSA/Blue System strategic and operational issues are identified and addressed with appropriate functional areas.

The Inter-Plan Affairs and Compliance Lead position works with varying levels of associates across all functional areas of the organization and will be one of a very few Blue Cross Blue Shield Association (BCBSA) subject matter authorities within the organization. This position will work with the business owners and cross-functional teams to engage key partners to develop and work on the overall implementation of Inter-Plan and BCBSA related business initiatives. This position provides work direction to partners participating on the initiative. This position is responsible to perform highly complex analytical work developing and implementing strategic business solutions through research, audit, and analysis of data.

A Day in the Life:

• Understand and remain informed about all facets of the Blue Cross Association and Blue Cross and Blue Shield of Minnesota, such as BCBSA Brand Licensure, Policy and protocol and inter-dependencies.
• Primarily manage the implementation of Inter-Plan related projects and policy mandates through the application of project management, meeting management and group facilitation skills.
• Maintain key relationships with Partner Blue Plans and BCBSA that will promote BCBSMN as a vital partner in the delivery of health care in a national arena in the local marketplace and in the Blues system.
• Collaborate with business partners to successfully articulate needs, identify project objectives, drive implementation, and communication plans.
• Represents BCBSMN in high visibility, influential Blue System roles, on Plan decision-making and advisory committees (e.g. National Programs Operations Work group), and in other appropriate System-wide forums (e.g. BlueCard Modernization meetings).
• Serves as backup to the Inter-Plan Executive, a point of accountability for BCBSMN's Association interactions.
• Provides high-level mentorship to work group participants facilitating strategic decision making to influence critical Association issues, to promote internal alignment enabling BCBSMN to speak with 'one voice on Association issues.
• Ensure the BCBSA Strategic Roadmap along with BCBSA initiatives, strategy, policy-making and inter-dependencies are aligned with the company strategy and business operations. May assist in the development of organization business policies.
• Work with BCBSMN SMEs and Leaders and Plan staff to communicate and exchange information on BCBSA initiatives, mandated activities, issues, problems, planning and performance, to ensure that BCBSMN is fully compliant.
• Identify and communicate BCBSA policy requirements for use in national account product and network development, advertising, public relations and BCBSMN compliance, through training and consultation with all levels of the organization.
• Ensures BCBSA Licensee compliance obligations to include assisting the oversight of Association audit requirements, performance measurements, coordinating any vital mitigation plans to avoid financial penalties and diminished reputation among the Blue organization.
• Leads all aspects of BCBSMN Plan participation on BCBS governance committees and work groups. Evaluates need for BCBSMN representation on new/existing BCBS committees/work groups, recommends appropriate internal staff for participation, obtains leadership approval. Ensures effective participation, common understanding of direction and alignment on issues for BCBSMN staff on key BCBS committees/work groups.
• Troubleshoot Inter-Plan raised issues with appropriate internal area on behalf of BCBSA and other Blue Plans. Coordinates resolution and communicates outcome between Plans.
• Supports the Inter-Plan Executive with the facilitation of the BCBSMN Internal Governance and Steering Committees on BCBSA affairs.
• Facilitate initiating, monitoring, and resolving all open Corrective Action Plans, as assigned by BCBSA.
• Initiate and support all Licensee Change Management Process events.

Nice to Have:

• Bachelor's degree in business or related field.
• Experience working directly with the BCBS Association Blue Plans.
• Experience working in Health Insurance.
• Experience as the business lead on large scale projects

Required Skills and Experiences:

• 7+ years of experience in project management, project implementation or consulting experience.
• Demonstrated organizational relationship management skills.
• Experience working with the ITS Claims Processing System.
• Advanced understanding of Blue System structure with the Blue Cross Association.
• Self-motivated, ability to work independently, and proven ability to work under tight timeframes in a highly visible position.
• Demonstrated ability to work effectively both independently and in a team setting with diverse professional backgrounds.
• Experience with development of formal business processes and methodologies
• Flexibility to handle a variety of responsibilities with proven organizational and multi-tasking skills.
• Ability to develop and present formal presentations.
• Proven interpersonal, problem-solving skills, conflict resolution, facilitation, and negotiation skills with the ability to exercise tact and diplomacy even in stressful situations.
• Strong knowledge of health insurance industry issues, trends, practices, products, and rate setting.
• Some overnight, long-distance travel may be required.
• Proficient in Microsoft Office Suite.
• Advanced level project management skills!

Make A Difference

Blue Cross is an Equal Opportunity and Affirmative Action employer that values diversity. All qualified applicants will receive consideration for employment without regard to, and will not be discriminated against based on race, color, creed, religion, sex, national origin, genetic information, marital status, status with regard to public assistance, disability, age, veteran status, sexual orientation, gender identity, gender expression, or any other legally protected characteristic.

Reasonable Accommodation for Job Seekers with a Disability: If you require reasonable accommodation in completing this application, interviewing, completing any pre-employment testing, or otherwise participating in the employee selection process, please direct your inquiries to talent.acquisition@bluecrossmn.com.

All roles require a high school diploma (or equivalency) and legal authorization to work in the U.S.

Blue Cross and Blue Shield of Minnesota and Blue Plus are nonprofit independent licensees of the Blue Cross and Blue Shield Association.