Manager, TPA Business Operations, Diversified Business Group
Job Description
The Blue Cross NC Diversified Business Group (DBG) is focused on driving improvements in health care, affordability, access and equity through investments and partnerships with innovative health care organizations in North Carolina and beyond. We have a history of forging forward-thinking partnerships and investments with like-minded partners to create the blueprint of the future of health care.
In this pivotal role, you will be responsible for driving operational performance and operational excellence of our subsidiary TPA businesses that serve groups in Local and National Self-Funded Markets. You will work collaboratively with senior leaders across DBG, our TPA subsidiaries, and the Blue Cross NC Enterprise to proactively monitor operational and product performance, optimize processes, and support capabilities to ensure we are delivering the highest possible value to our clients and members.
What You'll Do:
Define and proactively monitor KPIs to ensure performance excellence at the company, line-of-business, and product levels, working in partnership with the COOs and operational teams of our TPAs.
Listen intently to group, member, and market feedback; leverage your knowledge of the self-funded market to identify performance improvement opportunities.
Work closely with our product strategy, account management, and TPA SME teams to execute necessary process improvements to ensure our market offers/products are delivering exceptional experience and value to our self-funded clients.
Maintain, govern, and refine the operating model between DBG, our subsidiary TPAs, and Blue Cross NC Enterprise; work collaboratively and efficiently within a matrixed environment.
Support budget, resource, and execution planning with TPA subsidiaries to ensure they are positioned to deliver exceptional results on high-priority initiatives.
Ensure that our products/market offers meet appropriate regulatory, compliance and accreditation standards, including those of the BCBS Association. Proactively review accreditation and compliance rules to ensure cooperation with the organizational governance functions and that all product/market offer aspects remain current with formal expectations.
Lead the planning, development, and implementation of standard operating procedures and enterprise risk management practices and assist with the communication and education of new SOPs to key stakeholders within DBG and our subsidiaries.
Lead a team of high-performing individuals to execute on numerous initiatives in parallel; provide clear focus and prioritization of competing initiatives within an ambiguous and fast-paced environment. Leverage creative problem-solving skills and collaborative working relationships to drive progress.
What You'll Bring:
Bachelor's degree or advanced degree (where required)
8+ years of experience in related field.
In lieu of degree, 10+ years of experience in related field.
Preferred Qualifications:
Experience in operations and/or client support within a TPA specializing in commercial ASO market, with deep knowledge of self-funding and group benefits.
Exceptional communication, interpersonal, and stakeholder engagement skills with all levels of leadership.
Experience in developing process improvements to optimize program operations and support program success.
Ability to interpret and translate client feedback into definitive action plans to improve product performance.
Experience working within matrixed team structure to troubleshoot and overcome obstacles in a thoughtful and collaborative manner, with unwavering focus on exceeding client expectations.
Proficiency in project management, cross-functional team leadership, and root cause analysis.
What You'll Get:
Blue Cross NC is truly a great place to work - and we have the hardware to prove it. Each year, we're recognizedfor our commitment to our culture, community, work-life flexibility, benefits, diversity and more. Join us and help us make health care better for all!
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.
$105,600.00 - $191,800.00
Apply Now
The Blue Cross NC Diversified Business Group (DBG) is focused on driving improvements in health care, affordability, access and equity through investments and partnerships with innovative health care organizations in North Carolina and beyond. We have a history of forging forward-thinking partnerships and investments with like-minded partners to create the blueprint of the future of health care.
In this pivotal role, you will be responsible for driving operational performance and operational excellence of our subsidiary TPA businesses that serve groups in Local and National Self-Funded Markets. You will work collaboratively with senior leaders across DBG, our TPA subsidiaries, and the Blue Cross NC Enterprise to proactively monitor operational and product performance, optimize processes, and support capabilities to ensure we are delivering the highest possible value to our clients and members.
What You'll Do:
Define and proactively monitor KPIs to ensure performance excellence at the company, line-of-business, and product levels, working in partnership with the COOs and operational teams of our TPAs.
Listen intently to group, member, and market feedback; leverage your knowledge of the self-funded market to identify performance improvement opportunities.
Work closely with our product strategy, account management, and TPA SME teams to execute necessary process improvements to ensure our market offers/products are delivering exceptional experience and value to our self-funded clients.
Maintain, govern, and refine the operating model between DBG, our subsidiary TPAs, and Blue Cross NC Enterprise; work collaboratively and efficiently within a matrixed environment.
Support budget, resource, and execution planning with TPA subsidiaries to ensure they are positioned to deliver exceptional results on high-priority initiatives.
Ensure that our products/market offers meet appropriate regulatory, compliance and accreditation standards, including those of the BCBS Association. Proactively review accreditation and compliance rules to ensure cooperation with the organizational governance functions and that all product/market offer aspects remain current with formal expectations.
Lead the planning, development, and implementation of standard operating procedures and enterprise risk management practices and assist with the communication and education of new SOPs to key stakeholders within DBG and our subsidiaries.
Lead a team of high-performing individuals to execute on numerous initiatives in parallel; provide clear focus and prioritization of competing initiatives within an ambiguous and fast-paced environment. Leverage creative problem-solving skills and collaborative working relationships to drive progress.
What You'll Bring:
Bachelor's degree or advanced degree (where required)
8+ years of experience in related field.
In lieu of degree, 10+ years of experience in related field.
Preferred Qualifications:
Experience in operations and/or client support within a TPA specializing in commercial ASO market, with deep knowledge of self-funding and group benefits.
Exceptional communication, interpersonal, and stakeholder engagement skills with all levels of leadership.
Experience in developing process improvements to optimize program operations and support program success.
Ability to interpret and translate client feedback into definitive action plans to improve product performance.
Experience working within matrixed team structure to troubleshoot and overcome obstacles in a thoughtful and collaborative manner, with unwavering focus on exceeding client expectations.
Proficiency in project management, cross-functional team leadership, and root cause analysis.
What You'll Get:
Blue Cross NC is truly a great place to work - and we have the hardware to prove it. Each year, we're recognizedfor our commitment to our culture, community, work-life flexibility, benefits, diversity and more. Join us and help us make health care better for all!
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.
$105,600.00 - $191,800.00
Apply Now