Job Description

Blue Cross Blue Shield of Arizona is a local, independent Blue Cross Blue Shield Association and a not-for-profit health insurance company headquartered in Phoenix. Founded in 1939, the company has more than 1,800 dedicated employees throughout its Phoenix, Tucson, Chandler and Flagstaff offices. Providing health insurance products, services and networks to more than 1 million Arizonans, Blue Cross Blue Shield of Arizona offers various health plans for individuals, families, and small and large businesses. Blue Cross Blue Shield of Arizona also offers Medicare supplement plans to individuals over age 65.

Blue Cross Blue Shield of Arizona helps to fulfill its mission of improving the quality of life of Arizonans by delivering 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.

Purpose of the job

  • Manage Individual Segment Affordability by leading cross-functional cost of care team to extract and execute actionable insights that drive affordability and quality of BCBSAZ Individual and Family Product and Network offerings.  
  • Foster a disciplined and predictable approach to managing the cost of care and financial risk for the Individual segment, with the goal of creating more affordable products. 
  • Develop and execute a network strategy for the Individual segment, working collaboratively with Provider Partnerships to implement highly efficient, cost effective networks that meet the needs of individual customers.

SEGMENT NETWORK DEVELOPMENT

  • Lead the strategic development of new networks to meet evolving customer needs, including creation of multi-year strategies, priorities and roadmap to optimize Individual Segment product networks.
  • Prepare fact-based analysis and strategic recommendations to drive development of new/modified provider networks, including potential impacts of provider risk sharing.
  • Partner with Analytics and Provider Network teams to identify providers and locations practicing high value care for inclusion in current or future Exclusive Network offerings
  • Create and implement a continual and systematic network management process, partnering with other BCBSAZ functional areas to ensure Individual Segment product networks continue to meet adequacy and market needs over time.
  • Lead Individual Segment in Value-Based Partnerships, ensuring appropriate information sharing and monitoring outcome metrics in order to drive improved segment affordability and pricing predictability.
  • Develop a network competitive intelligence process to monitor the size and breadth of competitor networks and inform Individual Segment product network composition.

    PRODUCT AFFORDABILITY (COST OF CARE MANAGEMENT)

  • Lead Individual Segment cost of care management in identification, evaluation, implementation and monitoring of affordability and quality improvement initiatives designed to optimize the cost of high quality medical care.
  • Partner with Medical Directors and other HQA leadership to identify and implement effective utilization and care management activities, including strategic vendor partnerships as appropriate.
  • Identify, analyze, interpret and validate trends and patterns in Individual and Family Plan utilization across provider panels, care settings and other categories, advising segment leadership team of affordability challenges and potential mitigating actions
  • Provide leadership and segment representation on corporate committees, advocating for Individual customer needs and effectively communicating decisions and actions to segment leadership.
  • Oversee outsourced claims vendors to ensure appropriate execution of utilization and care management policies and accurate, timely payment of claims
  • Partner with Analytics to drive design and development of tools and reports that provide valuable insights leveraging a combination of internal and external data.
  • Monitor external economic and healthcare issues affecting cost and utilization trends impacting the industry, the organization and the segment.

    OVERALL

  • Oversee day-to-day departmental administration by coaching and motivating staff and departmental personnel to make maximum use of experience and skills.
  • Manage use of corporate funds including budgeting, financial management, and reporting. Identify opportunities to achieve administrative efficiencies while maintaining service.
  • Build and maintain effective working relationships with internal stakeholders and key external contacts 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.
  • Drive performance through management and execution of organizational plans and activities.
  • Coordinate activities between multiple divisions to achieve desired results.
  • Support BCBSAZ’s Core Value of maintaining a heritage of service through community involvement.
  • 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.

BCBSAZ 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.

Skills / Requirements

Qualifications

REQUIRED QUALIFICATIONS

  1. Required Work Experience
    • 7 years of management or supervisory experience
    • 5 years of experience in analytical, actuarial or financial business analysis leadership role
    • 5 years of experience working for a healthcare organization / health insurer
  1. Required Education
    • Bachelor’s Degree in general field of study
  1. Required Licenses
    • N/A
  1. Required Certifications
    • N/A

PREFERRED QUALIFICATIONS

  1. Preferred Work Experience
    • 10 years of management or supervisory experience
    • 7 years of experience in analytical, actuarial or financial business analysis leadership role
    • 7 years of experience working for a healthcare organization / health insurer
  1. Preferred Education
    • Bachelor’s Degree in Business, Healthcare, Mathematics, Economics, Finance or related field of study.
  1. Preferred Licenses
    • N/A
  1. Preferred Certifications
    • N/A
 

competencies

REQUIRED COMPETENCIES

  1. Required Job Skills
    • Intermediate PC proficiency
    • Intermediate proficiency with Microsoft Office, including Excel, Word and Powerpoint
    • Intermediate proficiency with Tableau or other data visualization tools.
    • Excellent presentation and communication sklls
    • Strong research and organization skills
  1. Required Professional Competencies
  • Advanced analytical and problem solving skills necessary to generate insights and recommendations based on available data
  • Ability to recognize strategic opportunities and use data to make timely and sound decisions
  • Excellent professional and interpersonal skills, including the ability to collaborate with team members and business stakeholders at all levels of the organization
  • Advanced project management experience.
  • Flexibility and willingness to adjust to shifting demands/priorities.
  • Strong customer service skills.
  1. Required Leadership Experience and Competencies
  • Management skills in an operationally changing environment, with drive for results and success based on planned objectives.
  • Ability to make decisions in a timely manner, sometimes with incomplete information and under tight deadlines
  • Ability to maintain high standard of performance while pursuing aggressive goals
  • Ability to influence key stakeholders to accomplish key objectives
  • Ability to maintain confidentiality and privacy
  • Principled leadership and sound business ethics

 

PREFERRED COMPETENCIES

  1. Preferred Job Skills
  • N/A
  1. Preferred Professional Competencies
    • N/A
  1. Preferred Leadership Experience and Competencies
    • N/A
 

Application Instructions

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