JOB SUMMARY
This job is responsible for leading the accountabilities of the Commercial Sales Markets operational compliance, business performance and strategic positioning as it relates to the Blue Cross Blue Shield Association (BCBSA), other Blue Cross Blue Shield (BCBS) Plans and the Consortium Health Plans (CHP) policies, mandates and pro-competitive strategic actions enacted by the BCBSA board. The incumbent is Highmark’s designated “National Account Executive” to the BCBSA, in addition to being Highmark’s ambassador with the BCBSA, other BCBS Plans and the CHP on Highmark Commercial Markets strategic initiatives. The incumbent supports all Commercial Sales Markets teams and assures maximize synergy with Finance, Sales Ops, Legal, Product Strategy, Customer Alignment, Provider, Actuary, HM Health Solutions, Health Plan Operations, Government Affairs and Advanced Analytics. This position also supports executive leadership related to interactions with BCBSA and other plans.
ESSENTIAL RESPONSIBILITIES
- Collaborate with all levels of management and staff from all Commercial Sales Markets to propose relevant Blue solutions and consistent messaging in order to deliver value to internal and external customers; acts as subject matter expert and trusted advisor on the national delivery of Blue commercial group business. This includes clearly communicating the value of BCBSA, CHP and other Blue strategic initiatives.
- Responsible for managing the cede negotiations and all aspects of the BCBSA Inter-Plan Program Policies related to ceding for the Pennsylvania and National Sales Markets. Currently a sizable annual risk of being recalled by home plans, if not administered by Highmark, or without strong corporate relationships with the associated blue plans.
- Responsible for the BCBSA and CHP financial Policies for the reimbursement of InterPlan fees when Highmark is the Control/Home Plan and Par/Host Plan. Works closely with Highmark’s Actuarial, National Business Finance and InterPlan Sales staffs. Serves as SME witness on Interplan operations, BCBSA policies and business practices in national and local court cases against Highmark and/or BCBSA; as such responsible for researching and understanding sufficient knowledge, and articulate such information in court or depositions, or assist senior management and legal counsel in preparing for associated legal matters.
- Maintain strong, credible, broad and deep relationships among BCBS Plan colleagues to manage membership retention and common sales strategies for Host BlueCard enrollment. Candidate would have a perspective of system strength and development around care delivery innovation and work closely with internal and external stakeholders to position national Blue narrow networks.
- Responsible for the review and, when required, proposing changes and/or recommendations to Inter-Plan Programs Policy changes impacting BlueCard fees, ceding and network issues as proposed to the Highmark representatives on the top most governance committees at the BCBSA (Market Solutions Committee, Commercial Markets Implementation Subcommittee and National Customer Advisory Council) and as proposed to Highmark’s CEO in preparation for the Board votes at BCBSA.
- Responsible for project management tasks for Commercial Sales Markets regarding strategic initiatives such as shared savings expertise, training teams on key BCBS competencies such as Inter-Plan Programs Policies and network access fees, CHP pricing strategies and other competitive financial levers.
- Provide support to the Senior Vice President, National Markets this position also supports the National Markets management team to identify, define and solve or recommend resolution to problems that impact the national delivery of National Markets clients.
- Represents Highmark on BCBSA and CHP Workgroups such as, the CHP Transfer Pricing Workgroup.
- Other duties as assigned or requested.
EDUCATION
Required
- Bachelor's in Business Administration or Health Care Management
Substitutions
- 6 years progressive experience in interplan/consultative/cede experience in lieu of Bachelor degree
Preferred
- None
EXPERIENCE
Required
- 5 years of BCBSA Inter-Plan Programs and Policies relating to the national delivery of commercial group business
- 3 years of experience in a consultative role that required interfacing and collaboration with BCBSA and BCBS Plans at all levels of management and staff
- 3 years of experience in a project management role with emphasis on leading the implementation of strategic initiatives AND/OR negotiating / defending administrative agreements
Preferred
- 3-7 years of experience in a consultative role that required interfacing and collaboration with BCBSA and BCBS Plans at all levels of management and staff
LICENSES or CERTIFICATIONS
Required
- None
Preferred
- None
SKILLS
- Excellent time management and project management skills
- Ability to prioritize and manage multiple projects
- Viewed as and expert by all levels of management
- Taking an unpopular position when required
- Superior institutional knowledge on BCBSA Inter-Plan Programs and Policies and the structure of BCBSA
- Negotiation experience and understanding of legal terminology
- Independent thinker and doer
- Encourages direct debate on critical issues
- Team based tactics for critical problem solving
- Superior relationships with BCBSA and BCBS Plan staff
- Strong relationships within the BCBS system and at other Blue Plans
- Knowledge of value and activity of Consortium Health Plans
- Networking skills to develop trust and loyalty among Blue Colleagues
Language (Other than English)
None
Travel Requirement
0% - 25%
PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS
Position Type
Office Based
Teaches / trains others regularly
Occasionally
Travel regularly from the office to various work sites or from site-to-site
Occasionally
Works primarily out-of-the office selling products/services (sales employees)
Never
Physical work site required
Yes
Lifting: up to 10 pounds
Constantly
Lifting: 10 to 25 pounds
Rarely
Lifting: 25 to 50 pounds
Does Not Apply
Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
Compliance Requirement: This position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.
Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.
Pay Range Minimum:
$118,400.00Pay Range Maximum:
$196,800.00Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.
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