Manager, Interplan Administrator at Blue Cross and Blue Shield of North Carolina in Durham, North Carolina

Posted in Other 10 days ago.

Job Description:

The majority of our roles will be work from home until the end of June 2021. We are evaluating when it is safe to begin working in the office again. Please talk with your Talent Advisor during the interview process for more information.

Additional Locations:

Out of State Teleworker (Alabama), Out of State Teleworker (Arizona), Out of State Teleworker (Colorado), Out of State Teleworker (Florida), Out of State Teleworker (Georgia), Out of State Teleworker (Idaho), Out of State Teleworker (Maryland), Out of State Teleworker (Michigan), Out of State Teleworker (Pennsylvania), Out of State Teleworker (Tennessee), Out of State Teleworker (Virginia)

Job Description

Our Underwriting Group is looking for an experience Interplan Administrator to lead our IPP Team in the role of Manager. Responsible for developing and communicating process, procedures, and pricing strategy for Interplan Administration functions. Ensures effective communication between Blue Plans and others involved in the support and delivery of national and local account business. Accountable for ensuring team members provide direct service and support to local and national multi-state accounts to meet corporate goals and objectives.

  • Manage, facilitate, and communicate changes and requirements for inter plan programs related to process, procedures, pricing, and ceding, including Consortium Health Plans.

  • Remain current with future capabilities of various plan documents and communicate results to BCBSNC plan personnel and other plans to improve performance standards. Work directly with Brokers, Consultants, Account Executives and other in coordinating activities related to retention and new sales.

  • Lead and participate in financial negotiations with other plans as well as internal partners, i.e. Sales, Underwriting and Account Management Teams. Contribute to the division's financial success by actively promoting BCBS home/host capabilities.

  • Lead and/or participate in projects, workgroups and other assignments inside and outside of division.

  • Plan, define, develop, install, monitor and regularly report on program to manage overall network service delivery for key BCBSNC customers.

  • Develop management level summary reports related to ceding and pricing and communicate said reports to Finance, Sales, and key stakeholders.

  • Conduct audits periodically of National Account files to ensure that new and existing groups are fully operational and setup correctly and operating within the company's/Association's required guidelines.

  • Develop and communicate internal and external guidelines to ensure support of home and host open enrollment activities.

Hiring Requirements

  • Bachelor's degree

  • 8 years of experience working with managed care products, finance and financial systems, policy and procedure interpretation, compliance regulations and/or industry regulations.

  • In lieu of degree, 10 years of experience as stated above