Senior Interplan Consultant

🕒 September 10

☕ Washington – Remote

☕ Washington – Remote

💵 $84.2k - $143.1k / year

⏰ Full Time

🟠 Senior

💼 Consultant

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 14%

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Premera Blue Cross

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1945

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Premera Blue Cross is an independent health insurance provider, serving businesses and residents of Washington State and Alaska as a licensee of the Blue Cross Blue Shield Association. The company offers a range of health plans including individual, family, employer-based, and Medicare Supplement plans. However, it has announced that it will exit the Medicare Advantage market as of January 1, 2025. Premera is committed to advancing health equity and community support, evident through its Social Impact Program focused on behavioral health and homelessness solutions in Washington and Alaska. Additionally, Premera complies with federal and state civil rights laws, offering language assistance services to ensure equitable care.

📋 Description

• Develop and execute renewal and growth strategies for Participating Plan business, including responses to RFIs and RFPs • Negotiate Participating Plan and Control Plan contracts and renewals, including service levels, funding arrangements, reimbursement methodologies, and related business terms • Partner with underwriting, operations, sales, account management, network management, and external stakeholders to achieve retention and growth objectives • Ensure compliance with Blue Cross Blue Shield Association requirements and contractual obligations • Serve as a liaison for National Labor Office and Taft-Hartley business activities • Develop and implement operational and business solutions supporting Control Plan and Participating Plan requirements • Coordinate compliance activities related to Medicare Advantage and other BCBSA requirements, including reporting and survey responses • Represent Premera on Blue Cross Blue Shield Association and Consortium Health Plans committees, workgroups, and governance forums • Coordinate and facilitate Inter-Plan activities involving Premera departments and other Blue Cross Blue Shield Plans • Oversee Inter-Plan operational processes, including plan profile management, reimbursement accuracy, and service delivery requirements • Monitor emerging industry, regulatory, and BCBSA developments and communicate business impacts to leadership • Deliver service to internal and external business partners while supporting Inter-Plan operational effectiveness • Perform other duties as assigned

🎯 Requirements

• Bachelor's degree in Business Administration, Healthcare Administration, or a related field, or an equivalent combination of education and experience • Eight (8) years of experience in healthcare, health insurance, account management, provider contracting, operations, InterPlan services, or related business functions • Experience supporting large employer groups, complex healthcare arrangements, or multi-state health plan operations • Must obtain and maintain a Washington State insurance agent license and additional state licenses as required • Experience working within a Blue Cross Blue Shield environment preferred • Experience managing Participating Plan or Inter-Plan business relationships preferred • Knowledge of provider networks, benefit structures, funding arrangements, and healthcare operations preferred • Demonstrated negotiation, influencing, and relationship-management skills • Strong understanding of healthcare funding arrangements, stop-loss products, utilization trends, and renewal strategies • Strong business acumen and analytical capabilities • Ability to work independently and make sound business decisions • Excellent problem-solving and critical-thinking skills • Strong verbal, written, and presentation communication skills • Ability to manage multiple priorities and stakeholders effectively • Ability to build effective partnerships across internal and external organizations • Strong customer-service orientation and consultative approach

🏖️ Benefits

• Medical, vision, and dental coverage with low employee premiums • Voluntary benefit offerings, including pet insurance • Life and disability insurance • 401K employer match • Pension plan vested after 3 years of service • Wellness incentives, including counseling services, stress management programs, and mindfulness programs • Generous paid time off • Tuition assistance for undergraduate and graduate degrees • Employee recognition program • On-campus flexibility, networking opportunities, and team engagement for hybrid employees • Commuter perks • Free convenient on-site parking • Subsidized on-campus cafes • On-site health and wellness activities • Fitness and well-being center with in-person and virtual workouts and nutritional counseling • On-site recreation including shuffleboard and ping pong