Senior Business Operations Advisor

Blue Cross and Blue Shield of North Carolina; Northern (KY); Hybrid; USD 89,000 - 143,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Parental leave and adoption support

Tuition reimbursement and career dev

401(k) with company match

Job summary

Blue Cross NC is seeking a senior leader to provide advanced business and operational support for Medicare Advantage and Medicare Supplement lines. The role focuses on strategic planning, budgeting, data analysis, and cross-functional collaboration to drive growth, profitability, and member experience.

Responsibilities include leading planning processes, coordinating leadership events, and delivering executive insights on key Medicare value levers such as Risk Adjustment, Star Ratings, and

Qualifications

• Bachelor’s degree or advanced degree; 5+ years experience in related field, or 7+ years without degree.

Responsibilities

• Lead business planning for Medicare Advantage and Medicare Supplement growth and performance.
• Coordinate and facilitate departmental events and leadership planning sessions to improve outcomes.
• Analyze data, monitor KPIs and budgets to drive profitability and member experience.
• Manage vendor relationships and cross-functional initiatives with Product, Operations, Finance and Data teams.
• Support strategic partnerships and provide executive-level insights and recommendations.

Skills

Business planning

Data analysis

Stakeholder management

Project management

Budget analysis

Medicare knowledge

Education

Bachelor's degree or advanced degree

Tools

Excel

Power BI

SQL

Job description

Job Description Provide advanced department, divisional and/or segment-focused business and operational leadership support for Medicare Advantage and Medicare Supplement lines of business, including business relationship management, business plan development, reporting, data and budget analysis, and execution of high-priority initiatives. Serve as a business partner in advancing growth, profitability, and member experience through key Medicare value levers including Risk Adjustment, Star Ratings, CAHPS, provider performance, network effectiveness, and operational execution.

What You’ll Do

Business and Strategic Planning

Build and facilitate repeatable business management processes that support Medicare Advantage and Medicare Supplement growth, profitability, compliance, and operational performance, including progress evaluation and communication to affected stakeholders. Lead the coordination, planning and facilitation of various departmental/divisional events (i.e. Departmental Summits, All Hands Meetings, Leadership Planning Sessions, staff meetings) to make them more effective, purposeful and outcomes based. Partner with leadership to monitor business performance and key Medicare value drivers including Risk Adjustment, Star Ratings, CAHPS performance, provider enablement, operational efficiency, retention, and membership growth. May produce segment business plans and analysis under guidance from Segment Lead. Facilitate the adoption of standard operating procedures and processes for the department and assist with the communication and education of new SOPs outside of the department. Facilitate change management work to support business and process improvements and overall departmental/divisional effectiveness.

Project Management

Lead special projects for the department/division/segment as assigned. Possible duties could include: Evaluation of potential opportunities and recommendations to reduce costs/improve efficiencies Review and evaluation of best or next practice opportunities for potential adoption Develop recommendations based on industry trends, CMS guidance, competitive intelligence, and market dynamics impacting Medicare Advantage and Medicare Supplement performance, growth, quality outcomes, and operational effectiveness. Serve as lead on engagements with external entities (i.e. consultants) and coordinate data gathering and research efforts based on the direction of leadership. Manage tracking of initiatives/projects for the department/division/segment and independently create presentations of initiative/project progress for varied audiences, which may include ILT and Senior Leadership.

Data Analysis/Reporting

Identify trends, risks, and opportunities impacting Medicare Advantage and Medicare Supplement performance and develop actionable recommendations for leadership. Coordinate departmental/divisional budget analysis, provide input into and monitor budget forecasts and review progress against administrative cost reduction goals Track and evaluate goal progress, including data collection and analysis of key performance metrics (KPIs).

Business Partnerships

Improve and strengthen business partnerships and stakeholder relationships for the department/division through focus on proactive communications, relationship building, and process improvements Facilitate the completion of the Annual Report, CEO/Board reports, and other marketing/communication opportunities with a focus on partnering to deliver communications that are relevant and oriented to specific business partnerships both internal and external. Provide input and recommended strategy for leadership’s public speaking engagements and/or industry Board or committee meetings. Coordinate and manage vendor relationships as required by business operations’ needs.

What You Have

Bachelor’s degree or advanced degree (where required) 5+ years of experience in related field. In lieu of degree, 7+ years of experience in related field.

Bonus Points

Demonstrated experience supporting Medicare Advantage and/or Medicare Supplement business operations, product performance, growth initiatives, or market management. Strong knowledge of Medicare value levers including Risk Adjustment, Star Ratings, CAHPS, provider performance, quality programs, and operational excellence. Experience translating complex business, operational, and market data into executive-level insights and recommendations. Proven ability to lead cross-functional initiatives involving Product, Operations, Clinical, Network, Finance, Actuarial, Marketing, and Data & Analytics teams. Knowledge of CMS regulations, Medicare product performance management, competitive market dynamics, and healthcare industry trends.

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

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. $89,174.00 - $142,679.00

Skills

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About Us

It’s an exciting time to work at Blue Cross and Blue Shield of North Carolina (Blue Cross NC). Health care is changing, and we’re leading the way. We offer more than health insurance our customers can count on. We’re committed to better health and better health care — in our communities and beyond. Our employees bring energy and creativity to the workplace, and it shows in our innovative approach to improving the health and well-being of North Carolinians. Blue Cross NC is a fully taxed, not-for-profit company headquartered in Durham, North Carolina. We serve more than 4.3 million members, and we employ more than 5,000 people across the country who are passionate about making health care better for all. Help us lead the charge for better health care by joining our award-winning team. Discover tremendous opportunities with us to do challenging and rewarding work. Opportunities that can lead you to a fulfilling career, work that can help others lead healthier, happier lives.

Authorization to Work in the United States

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Request Accommodations

Blue Cross NC provides reasonable accommodations to applicants with disabilities. If you need a reasonable accommodation for any part of the application or hiring process, please notify HR at [e-mail].

Blue Cross NC is a Hybrid Flex company. Whether the 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 of our approved states: Alabama, Arizona, Arkansas, Colorado, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Michigan, Mississippi, Missouri, North Carolina, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin, and Wyoming.