Manager Facets Configuration & Solutions

Please email [email protected] if you are a candidate seeking a reasonable accommodation for the application and/or interview process.

Schedule: Hybrid

Compensation: $95,700 - $159,400

Jump into the new world of health insurance:

At Blue Cross & Blue Shield of Rhode Island (BCBSRI), our business is healthcare. But our focus is on improving lives. Be part of a team that is large enough to make a difference but small enough to be innovative. Work in a rapidly changing field. Take a chance to be creative. Move outside the status quo. Shape new ideas with the power of a national brand behind you.

Join others who know diversity is strength:

We appreciate and celebrate everything that makes us unique: age, national origin, citizenship status, perspectives, experiences, physical or mental disability, military status, race, ethnicity, religion, gender, sexual orientation, gender identity and/or expression. Our diversity strengthens us as an organization and helps us better serve an increasingly diverse Rhode Island population.

Why this job matters:

Direct the administration and oversight of portfolio, contract, and ancillary configuration activities. Provide strategic direction, guidance, and insight to internal business areas to ensure that systematic and process changes meet customer expectations. Manage third party relationships and ensure vendor performance meets operational, financial, customer experience and contractual obligations. Provide consultation to the business on optimal architecture to drive business efficiencies and organizational capabilities. Ensure programs, plans and policies adhere to regulatory, accreditation, BCBS Association and corporate timelines and quality standards.

What you will do:

• Direct the end-to-end configuration activities for contract administration, product portfolio and ancillary administrative functions. Oversee vendor activities and ensure adherence to quality standards, deadlines, and customer expectations. Monitor daily operations to ensure alignment with state and federal requirements including but not limited to CMS, DOH, DOL, NCQA and BCBSA requirements.

• Direct third-party vendor relationships and provide strategic leadership and direction. Develop the appropriate monitoring and reporting tools to ensure performance is aligned with contractual obligations. Ensure that vendor performance meet service levels as outlined in contractual obligations. Serve as liaison between third party vendors and internal business areas to ensure successful communication and implementation of specific projects and initiatives.

• Collaborate with service delivery partner and external vendor partnerships on efficiency, transformation and automation opportunities.

• Contribute to development of corporate strategies, initiatives, and feasibility studies. Identify impact on accountable functions and make recommendations for efficient and effective implementation strategies.

• Serve as the conduit to corporate initiatives to ensure vendor priorities and staffing are aligned. Ensure vendor partner proposals, estimates, and solutions meet business objectives. Collaborate with peers to manage the direction of work activities at a strategic level.

• Champion the configuration and business architecture needs of the enterprise through participation on cross functional governance committees. Identify and implement improvements to the operational performance within the product portfolio and contracting administration space that will increase customer satisfaction and support business growth.

• Collaborate with external industry experts to understand opportunities and drive efficiency within the organization. Conduct clear and regular solution reviews that focus on improving performance and ensuring that the organization is informed of any new capabilities that should be considered in the planning and implementation process.

• Provide strategic leadership and direction to staff including performance management, employee development, and advancement of culture and DEI opportunities.

• Perform other duties as assigned.

What you need to succeed:

• Bachelor's degree in Information Technology, Health Care Administration, Computer Science or related field, or an equivalent combination of education and experience
• Knowledge of the health insurance and/or managed care industry with a focus on claims adjudication, enrollment, billing, customer service, and familiarity with computerized information tracking and processing systems-Facets preferred.
• Five or more years of product administration, and/or system configuration experience
• Three to five years management experience or experience leading a team
• Experience with application technology
• Comprehensive understanding product administration and configuration processes

• Understanding of outsourcing and vendor oversight responsibilities and service level agreements
• Ability to collaborate while dealing with complex situations.
• Ability to think creatively and drive innovation.
• Ability to convert business strategy into action-oriented objectives and measurable results.
• Effective decision-making skills with the ability to influence up and across the organization.
• Strong negotiating and consensus-building skills.
• Ability to coach and motivate to maximize performance.
• Ability to mentor, coach and provide guidance to others.
• Ability to effectively communicate vision, goals, and business objectives to employees.
• Excellent verbal and written communication skills, with ability to convey complex or technical information in an effective manner.

Location:

BCBSRI is headquartered in downtown Providence, conveniently located near the train station and bus terminal. We actively support associate well-being and work/life balance and offer the following schedules, based on role:

• In-office: onsite 5 days per week
• Hybrid: onsite 2-4 days per week
• Remote: onsite 0-1 days per week*.

*-Permitted to reside in the following states, pending approval from the Human Resources Department: Arizona, Florida, Georgia, Louisiana, North Carolina, Oklahoma, South Carolina, Texas, Rhode Island, Massachusetts, Connecticut and Virginia

At Blue Cross & Blue Shield of Rhode Island (BCBSRI), diversity and inclusion are central to our core values and strengthen our ability to meet the challenges of today's healthcare industry. BCBSRI is an equal opportunity, affirmative action employer. We provide equal opportunities without regard to race, color, religion, gender, age, national origin, disability, veteran status, sexual orientation, genetic information and gender identity or expression.

The law requires an employer to post notices describing the Federal laws prohibiting job discrimination based on race, color, sex, national origin, religion, age, equal pay, disability, veteran status, sexual orientation, and genetic information and gender identity or expression. Please visit https://www.eeoc.gov/employers/eeo-law-poster to view the "EEO is the Law" poster.

Other details

• Pay Type Salary

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