Sr Business Ops Advisor

Blue Cross and Blue Shield of North Carolina • Remote Flex - North Carolina, NC

19h • $89,174 - $142,679

About The Position

Provide advanced department, divisional and/or segment-focused business and operational leadership support for Medicare Advantage and Medicare Supplement lines of business, including business relationship management, business plan development, reporting, data and budget analysis, and execution of high-priority initiatives. Serve as a business partner in advancing growth, profitability, and member experience through key Medicare value levers including Risk Adjustment, Star Ratings, CAHPS, provider performance, network effectiveness, and operational execution.

Requirements

• Bachelor's degree or advanced degree (where required)
• 5+ years of experience in related field.
• In lieu of degree, 7+ years of experience in related field.

Nice To Haves

• Demonstrated experience supporting Medicare Advantage and/or Medicare Supplement business operations, product performance, growth initiatives, or market management.
• Strong knowledge of Medicare value levers including Risk Adjustment, Star Ratings, CAHPS, provider performance, quality programs, and operational excellence.
• Experience translating complex business, operational, and market data into executive-level insights and recommendations.
• Proven ability to lead cross-functional initiatives involving Product, Operations, Clinical, Network, Finance, Actuarial, Marketing, and Data & Analytics teams.
• Knowledge of CMS regulations, Medicare product performance management, competitive market dynamics, and healthcare industry trends.

Responsibilities

• Build and facilitate repeatable business management processes that support Medicare Advantage and Medicare Supplement growth, profitability, compliance, and operational performance, including progress evaluation and communication to affected stakeholders.
• Lead the coordination, planning and facilitation of various departmental/divisional events (i.e. Departmental Summits, All Hands Meetings, Leadership Planning Sessions, staff meetings) to make them more effective, purposeful and outcomes based.
• Partner with leadership to monitor business performance and key Medicare value drivers including Risk Adjustment, Star Ratings, CAHPS performance, provider enablement, operational efficiency, retention, and membership growth.
• May produce segment business plans and analysis under guidance from Segment Lead.
• Facilitate the adoption of standard operating procedures and processes for the department and assist with the communication and education of new SOPs outside of the department.
• Facilitate change management work to support business and process improvements and overall departmental/divisional effectiveness.
• Lead special projects for the department/division/segment as assigned.
• Develop recommendations based on industry trends, CMS guidance, competitive intelligence, and market dynamics impacting Medicare Advantage and Medicare Supplement performance, growth, quality outcomes, and operational effectiveness.
• Serve as lead on engagements with external entities (i.e. consultants) and coordinate data gathering and research efforts based on the direction of leadership.
• Manage tracking of initiatives/projects for the department/division/segment and independently create presentations of initiative/project progress for varied audiences, which may include ILT and Senior Leadership.
• Identify trends, risks, and opportunities impacting Medicare Advantage and Medicare Supplement performance and develop actionable recommendations for leadership.
• Coordinate departmental/divisional budget analysis, provide input into and monitor budget forecasts and review progress against administrative cost reduction goals.
• Track and evaluate goal progress, including data collection and analysis of key performance metrics (KPIs).
• Improve and strengthen business partnerships and stakeholder relationships for the department/division through focus on proactive communications, relationship building, and process improvements.
• Facilitate the completion of the Annual Report, CEO/Board reports, and other marketing/communication opportunities with a focus on partnering to deliver communications that are relevant and oriented to specific business partnerships both internal and external.
• Provide input and recommended strategy for leadership’s public speaking engagements and/or industry Board or committee meetings.
• Coordinate and manage vendor relationships as required by business operations’ needs.

Benefits

• Medical, dental, and vision coverage along with numerous health and wellness programs
• Parental leave and support plus adoption and surrogacy assistance
• Career development programs and tuition reimbursement for continued education
• 401k match including an annual company contribution

What This Job Offers

• Job Type: Full-time
• Career Level: Senior