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Director, Self-Funded Revenue Optimization (Hybrid)

AZ Blue Phoenix, AZ 85021, United States of America

Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy. AZ Blue offers a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.

At AZ Blue, we have a hybrid workforce strategy, called Workability, that offers flexibility with how and where employees work. Our positions are classified as hybrid, onsite or remote. While the majority of our employees are hybrid, the following classifications drive our current minimum onsite requirements:

  • Hybrid People Leaders: must reside in AZ, required to be onsite at least twice per week

  • Hybrid Individual Contributors: must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per week

  • Hybrid 2 (Operational Roles such as but not limited to: Customer Service, Claims Processors, and Correspondence positions): must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per month

  • Onsite: daily onsite requirement based on the essential functions of the job

  • Remote: not held to onsite requirements, however, leadership can request presence onsite for business reasons including but not limited to staff meetings, one-on-ones, training, and team building

Please note that onsite requirements may change in the future, based on business need, and job responsibilities. Most employees should expect onsite requirements and at a minimum of once per week.

This position requires work and residency within the state of Arizona.

PURPOSE OF THE JOB

· Provide strategic leadership and execution oversight for the development and implementation of a comprehensive self-funded revenue optimization strategy.

· Transform how value-added services are monetized for self-funded (ASO) customers, enabling revenue growth while supporting competitive reductions to core administrative fees.

· Lead cross-functional efforts to identify, price, operationalize, and commercialize innovative revenue-generating programs leveraging enterprise capabilities across clinical, payment integrity, analytics, and operations.

· Establish disciplined, predictable processes for identifying opportunities, building financial and pricing models, launching offerings, and tracking performance while minimizing customer abrasion.

QUALIFICATIONS

REQUIRED QUALIFICATIONS

1. Required Work Experience

· 7 years of progressive experience in the healthcare payer industry.

· 7 years of management experience.

· 5 years of experience supporting or leading self-funded (ASO) products, services, or pricing models.

· 5 years of experience in revenue optimization, value-based program monetization, payment integrity, or alternative pricing strategies (e.g., PMPM, shared savings).

· 3 years of experience leading complex, cross-functional initiatives in a matrixed environment.

· 3 years of experience in developing short and long range strategic plans, forecasting, and budgeting.

2. Required Education

· Bachelor’s degree in general field of study

3. Required Licenses

· N/A

4. Required Certifications

· N/A

PREFERRED QUALIFICATIONS

1. Preferred Work Experience

· 10 years of experience in healthcare payer operations or strategy.

· Direct experience in payment integrity, clinical programs, actuarial pricing, underwriting, or analytics.

· Experience designing and implementing shared savings, value-based, or performance-based revenue arrangements.

· Experience supporting Sales teams with commercialization, positioning, and client adoption of value-added services.

2. Preferred Education · Master’s degree in Business Administration

3. Preferred Licenses

· N/A

4. Preferred Certifications

· N/A

ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES

REVENUE STRATEGY & INNOVATION

  • Define and lead AZ Blue’s enterprise self-funded revenue optimization strategy.
  • Identify and prioritize monetization opportunities across payment integrity, clinical excellence, fraud, waste and abuse, analytics, and other value-added programs.
  • Develop business cases that quantify market opportunity, revenue impact, ROI, and financial sustainability.
  • Balance innovation with execution discipline to ensure scalable, repeatable solutions

FINANCIAL & PRICING MODEL DEVELOPMENT

  • Partner with Finance, Actuarial, and Underwriting teams to design alternative pricing approaches that shift revenue from administrative fees to value-based services.
  • Ensure pricing structures are competitive, compliant, financially sound, and aligned to market expectations.
  • Establish methodologies to measure financial performance, savings realization, and revenue outcomes.

GO-TO-MARKET & COMMERCIALIZATION

  • Lead packaging, positioning, and deployment of revenue-generating programs to the market.
  • Partner with Marketing and Sales to develop launch plans, sales enablement tools, and customer-facing materials.
  • Support Sales and Account Management teams to drive adoption while minimizing customer disruption and abrasion.
  • Ensure internal teams are trained and prepared to support new offerings.

CONTRACTING, COMPLIANCE & GOVERNANCE

  • Partner with Legal to ensure contracts appropriately reflect alternative pricing and revenue models.
  • Ensure compliance with regulatory, contractual, and internal governance requirements.
  • Establish standards for documentation, approvals, and ongoing program governance.

OVERALL

  • Oversee day-to-day departmental administration by coaching and motivating staff and departmental personnel to make maximum use of experience and skills.
  • Monitor quality performance measures, develop and maintain effective workflows, and seek to maximize efficiencies.
  • Manage use of corporate funds including budgeting, financial management, and reporting. Identify opportunities to achieve administrative efficiencies while maintaining service.
  • Maintain effective working relationships to ensure teamwork in achieving corporate goals.
  • Participate in strategic planning activities and contribute to departmental and cross-functional teams to achieve BCBSAZ goals and ensure future success.
  • Coordinate activities between multiple divisions to achieve desired results.
  • The position requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements.
  • Perform all other duties as assigned.

COMPETENCIES

REQUIRED COMPETENCIES

1. Required Job Skills

· Strong written and verbal communications.

· Ability to decipher and assimilate federal and state regulations.

· Intermediate PC proficiency.

· Intermediate skill in use of office equipment, including copiers, fax machines, scanner and telephones.

· Intermediate skill in word processing, spreadsheet and presentation software.

· Advanced knowledge of database and data analytic applications.

· Intermediate skill using departmental BCBSAZ and BCBSA software.

2. Required Professional Competencies

· Management skills in an operationally changing environment, with drive for results and success based on objectives.

· Intermediate knowledge of research, trends, and concepts.

· Advanced project management experience.

· Advanced knowledge of financial concepts and product management and development processes.

· Ability to assess cost and ROI and determine product feasibility in light of market demand.

· Strong customer service skills.

· Interpersonal skills that allow for harmonious relationships with providers, members and coworkers.

· Recognize strategic opportunities and use data to make timely and sound decisions.

· Flexibility and willingness to adjust to shifting demands/priorities.

· Ability and experience to assimilate multiple new functions, services, projects and systems while maintaining existing systems and programs.

3. Required Leadership Experience and Competencies

· High standard of performance while pursuing aggressive goals

· Principled leadership and sound business ethics

PREFERRED COMPETENCIES

1. Preferred Job Skills

· N/A

2. Preferred Professional Competencies

· N/A

3. Preferred Leadership Experience and Competencies

· N/A

Our Commitment

AZ Blue does not discriminate in hiring or employment on the basis of race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected group.

Thank you for your interest in Blue Cross Blue Shield of Arizona.  For more information on our company, see azblue.com.  If interested in this position, please apply.

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