Senior Interplan Consultant

This is a fully remote position, open to applicants in Washington.

📋 Description

• Formulate and implement strategies for the renewal and expansion of the Participating Plan business, encompassing responses to RFIs and RFPs.

• Negotiate contracts and renewals for the Participating Plan and Control Plan, which includes service levels, funding arrangements, reimbursement methodologies, and associated business terms.

• Collaborate with underwriting, operations, sales, account management, network management, and external stakeholders to meet retention and growth goals.

• Ensure adherence to Blue Cross Blue Shield Association standards and contractual commitments.

• Act as a liaison for National Labor Office and Taft-Hartley business initiatives.

• Create and implement operational and business solutions that align with Control Plan and Participating Plan needs.

• Oversee compliance activities tied to Medicare Advantage and other BCBSA regulations, including reporting and survey submissions.

• Represent Premera within Blue Cross Blue Shield Association and Consortium Health Plans committees, workgroups, and governance forums.

• Organize and facilitate Inter-Plan activities involving departments at Premera and other Blue Cross Blue Shield Plans.

• Manage Inter-Plan operational processes such as plan profile maintenance, reimbursement accuracy, and service delivery standards.

• Track emerging industry trends, regulatory changes, and BCBSA developments, communicating potential business impacts to leadership.

• Provide service to both internal and external business partners while enhancing Inter-Plan operational efficiency.

• Perform additional duties as assigned.

⛳️ Requirements

• A Bachelor's degree in Business Administration, Healthcare Administration, or a related discipline, or an equivalent combination of education and experience.

• At least eight (8) years of experience in healthcare, health insurance, account management, provider contracting, operations, InterPlan services, or related business areas.

• Experience in supporting large employer groups, complex healthcare arrangements, or multi-state health plan operations.

• Must secure and maintain a Washington State insurance agent license and any additional state licenses as necessary.

• Prior experience in a Blue Cross Blue Shield environment is preferred.

• Experience in managing Participating Plan or Inter-Plan business relationships is preferred.

• Familiarity with provider networks, benefit structures, funding arrangements, and healthcare operations is preferred.

• Proven negotiation, influencing, and relationship-management abilities.

• Strong understanding of healthcare funding arrangements, stop-loss products, utilization trends, and renewal strategies.

• Solid business acumen and analytical skills.

• Capability to work independently and make informed business decisions.

• Excellent problem-solving and critical-thinking abilities.

• Strong verbal, written, and presentation communication skills.

• Competence in managing multiple priorities and stakeholders effectively.

• Ability to forge effective partnerships across internal and external organizations.

• Strong customer-service orientation and a consultative approach.

🏝️ Benefits

• Comprehensive medical, vision, and dental coverage with low employee premiums.

• Optional benefit offerings, such as pet insurance.

• Life and disability insurance.

• 401K employer matching program.

• Pension plan eligibility after three years of service.

• Wellness incentives, including counseling services, stress management programs, and mindfulness initiatives.

• Generous paid time off policy.

• Tuition assistance for undergraduate and graduate education.

• Employee recognition program.

• On-campus flexibility, networking opportunities, and team engagement for hybrid workers.

• Commuter benefits.

• Convenient free on-site parking.

• Subsidized on-campus dining options.

• On-site health and wellness activities.

• Fitness and well-being center featuring both in-person and virtual workouts, as well as nutritional counseling.

• On-site recreational activities, including shuffleboard and ping pong.