DurhamRecruiter Since 2001
the smart solution for Durham jobs

State Health Plan Operations Director

Company: Blue Cross and Blue Shield of North Carolina
Location: Durham
Posted on: September 13, 2019

Job Description:


The State Health Plan (SHP) Operations Director has primary responsibility to ensure successful delivery of the end to end operational functions supporting the SHP, our company s largest ASO customer. In a matrix relationship, this Director role will have authority for operational direction and decision making for the membership/billing, claims, and customer service functions. This position will serve as subject matter expert and act as the primary point of contact for the external customer requiring interaction with the State Treasure as well as the State Health Plan leadership and staff reporting to the Treasurer. Also, this key role will work with internal business owners, segment leadership, and other business partners.

* Maintain and leverage deep expertise of designated business channel, including policies, end to end procedures, contract requirements and unique needs, providing advice and support across CGSO functions.

* Act as decision maker on key operational issues taking accountability for operational performance results and meeting customer expectations

* Serve as the primary point of contact to the external customer on end to end operational needs with a strong focus on timely and accurate issue resolution and root cause analysis

* Represent operational needs and interests for line of business with Sales team, performing analysis of historical operational data and projections to inform product offerings and contract negotiations

* Champion channel-specific needs throughout the organization, assisting Core Production and Core Service leadership with management of escalations, complex issues and ongoing problems

* Within a matrix structure, lead and collaborate with Core Production and Service leads to identify areas that drive member and customer escalations

* Support management and execution of strategically-aligned, channel-specific projects, including process updates, system changes, compliance actions, etc.

* Prepare the team and internal customers for future changes to improve account implementation service, group on boarding, and eligibility maintenance process overall.

* Identify and establish new processes and methodologies to improve the ability of team to successfully deliver member and group enrollment.

* Create and update dashboards to monitor performance of key metrics

* Hold weekly onsite meeting with the SHP leadership to provide updates on ongoing performance, improvements and future initiatives


* Bachelor s degree

* 8 years of experience in operational leadership covering a variety of functions including membership/billing, claims, customer service and the interface with the financial and reporting functions.

* A background in client relations, account management or liaison role in marketing and/or operations in the insurance industry.

* Must have solid understanding of end to end operational process


* Proven experience in a customer facing role, effectively managing customer/client expectations while balancing internal organization needs.

* Excellent oral and written communication skills

* Strong communication and negotiation skills

* Ability to proactively identify issues or concerns and strong risk mitigation skills

* Ability to manage relationships and create stakeholder buy-in

* Strong customer service and team building skills

* Good sense of policy implication on contract performance.

* Ability to effectively manage multiple priorities and projects

* Consistent demonstration of leadership behaviors ( i.e. training, mentoring, assisting peers with issue resolution)


Blue Cross and Blue Shield of North Carolina does not discriminate on the basis of race, color, national origin, sex, age or disability in its health programs and activities.

Keywords: Blue Cross and Blue Shield of North Carolina, Durham , State Health Plan Operations Director, Healthcare , Durham, North Carolina

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category

Other Healthcare Jobs

Endocrinology Fellowship Program Director (Physician #)
Description: An AOA and ACGME approved Internal Medicine Residency is seeking a Program Director to provide professional expertise and leadership to develop a new proposed Endocrinology, Diabetes, Metabolic Fellowship (more...)
Company: Necnic Group, LLC
Location: Raleigh
Posted on: 09/20/2019

Adult or Child/Adolescent Psychiatrist (Physician #15757)
Description: Downtown Raleigh facility has immediate need for a child and /or adult psychiatrist working
Company: FCSpsy
Location: Raleigh
Posted on: 09/20/2019

Travel RN-Medical Surgical - Raleigh, NC
Description: Operating Room/Ambulatory Care/MedSurg opening in Raleigh, North Carolina. This and other rn jobs brought to you by NursingJobCafe.com ul li RNnetwork has an excellent
Company: RNnetwork
Location: Raleigh
Posted on: 09/20/2019

Physician Assistant Locum Tenens needed this Friday 9/20 in Raleigh, NC
Description: Family Practice/Primary Care opening in Raleigh, North Carolina. This and other physician assistant
Company: Medstaff National Medical Staffing
Location: Raleigh
Posted on: 09/20/2019

Gastroenterology Physician Job near Raleigh, North Carolina (Physician
Description: Permanent opening for two Gastroenterologist to join an established, private practice near Raleigh, North Carolina. --- Seeking Board Certified Gastroenterologist
Company: HDA MD Staff
Location: Raleigh
Posted on: 09/20/2019

Occupational Therapist (OT) Travel Job
Description: Jackson Therapy Partners has immediate travel opportunities for experienced Occupational Therapy professionals OT in the North Carolina. You'll enjoy an incredibly supportive and ambitious team at Jackson (more...)
Company: Jackson Therapy Partners
Location: Raleigh
Posted on: 09/20/2019

Coastal North Carolina Practice - Outpatient Only (Physician #)
Description: Inner-banks coastal North Carolina outpatient position available with an established practice. This beautiful and historic community offers wonderful
Company: The Curare Group, Inc
Location: Raleigh
Posted on: 09/20/2019

Shift Model Nocturnist - One Hour from Raleigh, North Carolina
Description: Hospitalist opening in Raleigh, North Carolina. This and other physician jobs brought to you by DocCafe.com ul li A successful multi-specialty
Company: Integrity Healthcare
Location: Raleigh
Posted on: 09/20/2019

CNA 3rd shift - SOB available
Description: Job Details Company Overview Description JOB PURPOSE: Provides each of the assigned patients with routine daily nursing care and services in accordance with the patient's assessment and care plan, and (more...)
Company: Pruitt Health
Location: Raleigh
Posted on: 09/20/2019

Locum Tenens Physician Obstetrics and Gynecology Call Coverage (Physic
Description: Medstaff has been providing coverage for this facility since 2004 and we are looking to add a couple providers to our locum tenens team. We are seeking a board
Company: Medstaff National Medical Staffing
Location: Raleigh
Posted on: 09/20/2019

Log In or Create An Account

Get the latest North Carolina jobs by following @recnetNC on Twitter!

Durham RSS job feeds