United States onlyJob Description
Leads efforts to achieve innovation-based goals through new forms of healthcare reimbursement, healthcare redesign consultation, payer/provider engagement and market offer opportunities. Leverages extensive industry experience and expertise to promote enterprise understanding of the key areas in which the company is seeking to create competitive differentiation and establish sustainable competitive advantage in the marketplace.What You’ll Do
Consult with ASO clients on pharmacy benefits, programs, and pricing strategies.
Analyze client data to evaluate cost‑savings opportunities and identify utilization and cost trends.
Conduct quarterly and annual utilization review meetings with clients.
Manage relationships with ASO clients, medical sales partners, and external consultants.
Proactively identify, evaluate, and lead healthcare redesign, provider reimbursement, and partnership strategies to support BCBSNC’s growth objectives while managing healthcare costs and improving member outcomes and experience.
Support and manage development efforts for the enhancement and ongoing maintenance of current products and market offer components.
Lead critical activities including strategic planning, complex quantitative and qualitative analysis, and thought leadership at both departmental and enterprise levels.
Present strategic concepts, planning insights, medical expense and reimbursement data, provider performance metrics, and impact assessments to internal and external audiences, including senior leadership.
Organize, optimize, and communicate progress toward completion of the overall work portfolio.
Collaborate with cross‑functional partners across the enterprise, serving as a subject matter expert in healthcare delivery transformation, reimbursement, and strategy.
Identify, analyze, and monitor industry, regulatory, technology, and market trends impacting divisional operations, provider reimbursement, medical expense strategy, and payer‑provider dynamics.
Drive operational improvements through advanced analytics and reporting, project management methodologies, and consulting or engagement approaches.
Serve as a mentor and coach to junior team members and oversee workstreams or deliverables as needed.
What You Bring
Bachelor’s degree or advanced degree (where required), or equivalent experience.
8+ years of experience in a related field.
In lieu of a degree, 10+ years of relevant professional experience.
Great to Have
Experience with PBMs or pharmacy operations.
Client‑facing sales or consultative experience.
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.
$130,560.00 - $208,896.00Skills
Healthcare Operations, Healthcare Process Improvement, Healthcare Reimbursement, Operational Efficiency, Operational Process Improvements, People Management, Project Management, Provider Reimbursement, Reporting and Analysis, Strategic Planning
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: HR.Staffing@BCBSNC.com.
