Director, InterPlan Operations

October 10, 2024

Industry: Private

Employment Type:- Full Time

Work Hours:- 8 Hours

Locations:- USA

Full Job Description:-

At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.

Join HCSC and be part of a purpose-driven company that will invest in your professional development.

Job Summary This position is responsible for planning, action, and oversight of BCBSA Strategic Initiatives to ensure compliance with BCBSA InterPlan policy, mandates, and procedures, as well as implementation, administration, and retention of Group, Government and Retail lines of business in compliance with BlueCard Policy and Procedures. This position is also responsible for supporting HCSC leadership, sales and account management teams; serving as HCSC's business owner over all BCBSA national provider data and ensure point solution vendor compliance with InterPlan policy. The team will also provide governance and oversight to the interactions between HCSC and BCBSA.

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Job Responsibilities:

Strategic Initiative Compliance

Plan, direct, and oversee construction and maintenance of HCSC capabilities to ensure compliance with BCBS Association Board Directives involving BlueCard, and internal HCSC initiatives to drive sales, retain groups, and innovate for anticipated future needs of our Enterprise and National account business.

BlueCard Policy Compliance

Oversee HCSC compliance with Association IP Policy, as required by our Licensure Agreement with the BCBS Association.
Coordinate with any HCSC department (e.g. Audit, ITG, SDO, Legal, SIU), in the support and development of BlueCard appropriate/compliant responses and actions to questions and implementation of solutions.
Participate in the enhancement/development of IP Policy compliant service, guidelines, and procedures to support any staff initiatives necessary to the success of the BlueCard program.
When found out of compliance ensure appropriate reporting to the Association, develop and oversee action plans to bring HCSC into compliance.

National Data Management

Support HCSC leadership (Data Board and Data Board Advisory Subcommittee) with regards to national provider data strategy and operations.
Ensure BCBSA national provider data mandates are met (eg. NCCT, PDR, PQM, PRS, etc).
Support national account business when groups experience national account provider data issues.

BlueCard Executive

Act as HCSC's primary person responsible for the BlueCard Program on a day to day basis and provide direction on the future of Inter-Plan Programs.
Act as the primary HCSC contact for BlueCard Program and Program related escalations, and compliance issues. Ensure that HCSC is maximizing the value of the BlueCard Program for all constituents: internal plan staff, partner Blue-Plans, members, accounts and providers.
Oversee operational interfaces/relationships between HCSC and Host/Home partner BCBS Plans and the BCBS Association in relation to the BlueCard Program, and resolution of Complex BlueCard Issues (e.g. settlement negotiation, provider compliance, complex care management, non-par provider, potential fraud and legal issues).
Serve as HCSC's primary liaison to the Association and partner plans in the resolution of Formal Disputes (3-Day Dispute Resolution). Drive HCSC's InterPlan position by creating solutions and strengthening relationships with Blue Partners to improve the customer and provider brand experience.

Incident Response and Crisis Management

Participate in all Preparedness and Response Activities. (Calls, Meetings, War Games, Playbook Review and Development etc).
Develop, Review, and Approve responses to all group questions regarding Crisis, taking into account the need for absolute accuracy and both corporate and personal risk of litigation.
Review and Approve HCSC Corporate Information Security Statement, Review and Approve HCSC SOC 2 Report in conjunction with Legal for release to ASO groups and other interested parties, Develop and Maintain the HCSC Marketing Crisis Response Action Plan.

Legal Liaison

Serve as primary BlueCard point of contact/consultant to HCSC Legal, recommending BlueCard compliant solutions to evolving issues. Act as liaison with partner Blue Plans in resolving issues

Required Job Qualifications:

Bachelor's degree and 10 years of experience in managed care/health insurance marketing support, insurance administration or claims operations.
5 years supervisory experience.
Knowledge of the principles and specifics of provider contracting and claim pricing methodologies.
Knowledge of corporate marketing practices, product lines and Par Plan operations.
Ability to manage multiple projects.
Organizational and leadership skills.
Interpersonal, verbal and written communication skills.

Preferred Job Qualifications:

Masters Degree.
Experience in crisis management/incident response and protocol