Blue Cross NC ยท 3 hours ago
Manager, TPA Business Operations, Diversified Business Group
Remote - North Carolina
Full-time
Remote
Mid, Senior Level
$106K/yr - $192K/yr
8+ years exp
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Responsibilities
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.
Qualification
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Required
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
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.
Benefits
Annual Incentive Bonus
401(k) with employer match
Paid Time Off (PTO)
Competitive health benefits and wellness programs
Company
Blue Cross NC
It's an exciting time to work at Blue Cross and Blue Shield of North Carolina (Blue Cross NC). Health care is changing, and we're leading the way.
5001-10000 employees
H1B Sponsorship
Blue Cross NC has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2023 (2)
2022 (5)
2021 (7)
2020 (11)
Funding
Current Stage
Late StageLeadership Team
Priscilla Alfaro
VP- Payment Integrity
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