Associate Counsel - State Health Plan Administration

Blue Cross and Blue Shield of North Carolina; Indiana (PA); Hybrid; USD 131,000 - 209,000; Full time

Job summary

Blue Cross NC is seeking an Associate Counsel to join our legal team, providing day-to-day support for the State Health Plan TPA contract. You will collaborate with operational, compliance, finance, data, and executive teams to ensure contractual compliance and effective execution.

The role involves drafting and negotiating provider and vendor agreements, advising on HIPAA and privacy matters, supporting audits, and guiding strategic health plan initiatives.

Qualifications

• Graduate of an accredited law school.
• 3+ years of experience in related field.
• Licensed to practice law in North Carolina or must obtain license within one year of employment.

Responsibilities

• Serve as dedicated legal counsel supporting Blue Cross NC's administration of the State Health Plan TPA contract.
• Act as the day-to-day resource for business teams supporting the State Health Plan account, providing timely legal guidance on operational, contractual, regulatory, and implementation matters.
• Develop and maintain deep subject matter knowledge of the State Health Plan contract, including performance guarantees, service levels, reporting obligations, implementation requirements, financial provisions, audit rights, and operational commitments.
• Research and analyze federal and state laws, regulations, administrative guidance, and case law applicable to health plans, government programs, and third-party administration services.
• Draft, review, and negotiate a variety of legal documents, including provider agreements, data sharing agreements, vendor agreements, business associate agreements, amendments, and operational documentation.
• Support implementation and ongoing administration of State Health Plan initiatives, benefit changes, network arrangements, and vendor integrations.
• Advise business partners on compliance with HIPAA, HITECH, privacy, security, data governance, and information-sharing requirements.
• Support responses to audits, investigations, administrative inquiries, regulatory requests, and contractual compliance reviews.
• Assist with public records requests, confidentiality analyses, and protection of trade secret and proprietary information.
• Monitor legal, regulatory, and legislative developments impacting the State Health Plan, government health programs, and health plan administration and communicate practical implications to business stakeholders.
• Provide legal support related to appeals, grievances, provider disputes, claims administration issues, and member complaints.
• Develop and deliver training to business partners on legal and compliance topics.
• Support strategic initiatives involving value-based care, alternative payment models, provider contracting, and network innovation.
• Draft and review executive communications, board materials, regulatory responses, and other business-facing legal guidance.
• Provides support on developing legal issues and performs other duties as assigned.

Skills

Legal experience

Contract review

HIPAA knowledge

Regulatory compliance

Communication skills

Education

Juris Doctor (JD)

Job description

Job Description

We're seeking an Associate Counsel to join our legal team as dedicated legal support for Blue Cross NC's Third-Party Administrator (TPA) services provided to the North Carolina State Health Plan for Teachers and State Employees. This position is assigned specifically to the State Health Plan account and will work closely with the business teams responsible for day-to-day administration, implementation, compliance, and operational oversight of the contract. This role is well-suited for an attorney interested in working at the intersection of health care, government programs, public procurement, and large-scale health plan operations.

The Associate Counsel will serve as the primary day-to-day legal advisor supporting Blue Cross NC's administration of the State Health Plan contract. This position will partner closely with operational, network, implementation, compliance, finance, data, and executive teams to help ensure contractual compliance, manage legal risk, and support successful execution of complex health care contracts.

This role offers exposure to high-profile legal and business issues, including government contracting, public records laws, health plan administration, provider contracting, regulatory compliance, appeals and grievance processes, and implementation of innovative benefit and network strategies.

What You'll Do

• Serve as dedicated legal counsel supporting Blue Cross NC's administration of the State Health Plan TPA contract.
• Act as the day-to-day resource for business teams supporting the State Health Plan account, providing timely legal guidance on operational, contractual, regulatory, and implementation matters.
• Develop and maintain deep subject matter knowledge of the State Health Plan contract, including performance guarantees, service levels, reporting obligations, implementation requirements, financial provisions, audit rights, and operational commitments.
• Research and analyze federal and state laws, regulations, administrative guidance, and case law applicable to health plans, government programs, and third-party administration services.
• Draft, review, and negotiate a variety of legal documents, including provider agreements, data sharing agreements, vendor agreements, business associate agreements, amendments, and operational documentation.
• Support implementation and ongoing administration of State Health Plan initiatives, benefit changes, network arrangements, and vendor integrations.
• Advise business partners on compliance with HIPAA, HITECH, privacy, security, data governance, and information-sharing requirements.
• Support responses to audits, investigations, administrative inquiries, regulatory requests, and contractual compliance reviews.
• Assist with public records requests, confidentiality analyses, and protection of trade secret and proprietary information.
• Monitor legal, regulatory, and legislative developments impacting the State Health Plan, government health programs, and health plan administration and communicate practical implications to business stakeholders.
• Provide legal support related to appeals, grievances, provider disputes, claims administration issues, and member complaints.
• Develop and deliver training to business partners on legal and compliance topics.
• Support strategic initiatives involving value-based care, alternative payment models, provider contracting, and network innovation.
• Draft and review executive communications, board materials, regulatory responses, and other business-facing legal guidance.
• Provides support on developing legal issues and performs other duties as assigned.

What You Bring

• Graduate of an accredited law school required.
• 3+ years of experience in related field.
• Licensed to practice law in North Carolina or must obtain license within one year of employment.

Bonus Points

• Experience supporting self-funded health plans, third-party administrator operations, health insurers, government-sponsored health programs, or large employer group health plans.
• Experience advising on ERISA, HIPAA, ACA, Medicare, Medicaid, health care privacy, or insurance regulatory matters.
• Experience negotiating and administering complex service agreements, provider contracts, and health care vendor arrangements.
• Familiarity with public procurement, government contracts, bid protests, and public records laws.
• Experience supporting implementation of large-scale health care operational initiatives or enterprise projects.
• Knowledge of claims administration, appeals and grievances, utilization management, network management, or health plan operations.
• Strong issue-spotting ability and demonstrated judgment in identifying and escalating legal and compliance risks.
• Ability to translate complex legal requirements into practical business guidance.
• Excellent written and oral communication skills, including experience supporting senior leadership and cross-functional teams.
• Collaborative approach to client service and relationship management.
• Intellectual curiosity, adaptability, and a strong learning mindset.

What You'll Get

• The opportunity to work at the cutting edge of health care delivery with a team that's deeply invested in the community.
• Work-life balance, flexibility, and the autonomy to do great work.
• Medical, dental, and vision coverage along with numerous health and wellness programs.
• Parental leave and support plus adoption and surrogacy assistance.
• Career development programs and tuition reimbursement for continued education.
• 401k match including an annual company contribution.

Where You'll Work

Our Hybrid Flex approach is built on presence with a purpose - giving you flexibility to work remotely with intentional in-person connection - that supports a workplace that’s flexible, connected, and future focused.

In a Hybrid-Flex role, you’ll work in the office at least two days a week for collaboration and connection. In a Remote Flex role, you’ll work virtually, with a few in-office visits each year for meaningful moments that matter.

Whether your role is Hybrid Flex or Remote Flex depends on the nature of the work and distance from our Durham headquarters. We welcome candidates from outside the local area and in any states listed on this job posting. Onsite expectations will be discussed during the interview process.

Salary Range

At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs. Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs.

*Based on annual corporate goal achievement and individual performance.

$130,560.00 - $208,896.00

Skills

Business Contracts, Contract Evaluations, Contract Management, Contract Negotiations, Contract Operations, Contracts Analysis, Government Affairs, Law, Legal Agreements, Legal Compliance, Legal Documents Preparation, Legal Practices, Legal Representation, Legal Services, Outside Counsel Management, Regulations, Regulatory Compliance, Regulatory Filings, Statutory Interpretation