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Director of Operational Services, Medicare Advantage job in Columbia at Blue Cross and Blue Shield Association

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Director of Operational Services, Medicare Advantage at Blue Cross and Blue Shield Association

Director of Operational Services, Medicare Advantage

Blue Cross and Blue Shield Association Columbia, SC Full-Time

Lead and direct the creation/execution of the strategic plan and ensures goals are met in accordance with the plan. Responsible for the coordination and direction of operations, including administration of staff, reporting and strategic development.


Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but for more than seven decades we've been part of the national landscape, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina … and much more. We are one of the nation's leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies that allows us to build on a variety of business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team!

Position Purpose

The Director of Operations for Medicare Advantage will lead and direct the creation/execution of the strategic plan and ensures goals are met in accordance with the plan. You will be responsible for the coordination and direction of operations, including administration of staff, reporting and strategic development. This leader must have a strategic mindset to build the vision and plan and the operational skill set to implement the strategy while driving the efficiency and scalability of the operations.

What you'll do:

* Directs multi-functional area handling but not limited to: customer service, claims, membership, client support, appeals, training, customer service, provider services, implementation, installation of new business and technical activities. Ensures business operations including claims processing, systems, and/or membership services functions meet all timeliness and quality standards.

* Develops/administers training and educational programs and materials for staff.

* Develops short and long term objectives for area and continuously monitors procedures to ensure compliance with all regulations that may be issued weekly, monthly, and annually.

* Provides solutions, systems and processes for all operations and aspects of the business. May make decisions regarding development and acquisition and software development and licensing with regard to operational capability, relevance and budget.

* Develops, produces and distributes reporting for all aspects of the business as needed. Oversees both internal and external audits and develops remediation plans if needed.

* Supports executive management, vendors and clients. Determines appropriate metrics and reporting for strategic planning and monitoring.

To Qualify for This Position, You'll Need:

* Bachelor's degree in any major. OR

* 4 years of industry-related experience.

* 10+ years of related business experience including experience leading management teams and other staff.

* Strong organizational and leadership skills.

* Superior analytical or critical thinking skills.

* Excellent decision-making or problem-solving skills.

* Excellent verbal and written communication, including presentation skills.

* Knowledge and expertise in developing, monitoring and overseeing budgetary responsibilities to ensure expenditures are cost effective and justified within budget.

* Microsoft Office Suite.

We prefer you have:

* Master's degree-in Business Administration.

* At least 5 years of Medicare Advantage or Fee-for-Service(FFS) Operations and/or Medicare Advantage or Fee-for-Service(FFS) Compliance experience

* Experience with Medicare Advantage including but not limited to Claims, CMS Change Management, Customer Service, Enrollment, Billing, Appeals, and Grievances.

* Medicare Part D experience.

Work Environment:

* Typical office environment, located at 17 Technology Circle, Columbia, SC

* Some infrequent travel may be required.

What We Can Do for You:

We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have access and opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company.

Our comprehensive benefits package includes:

* 401(k) retirement savings plan with company match

* Health Insurance

* Free vision coverage

* Voluntary dental, vision, and life insurance

* Paid annual leave - the longer you work here, the more you earn

* Nine paid holidays

* On-site cafeterias and fitness centers in major locations

* Wellness programs and a healthy lifestyle premium discount

* Tuition assistance

* Service recognition

What to Expect Next:

After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements. Management will be conducting interviews with those candidates who qualify with prioritization given to those candidates who demonstrate the preferred qualifications.

We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.

Equal Employment Opportunity Statement

BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains Affirmative Action programs to promote employment opportunities for minorities, females, disabled individuals and veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.

We are committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities.

If you need special assistance or an accommodation while seeking employment, please e-mail [ Email address blocked ] - Click here to apply to Director of Operational Services, Medicare Advantage or call
, ext. 43172 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.

Recommended Skills

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