Director of BlueCard Services

Position Summary

Responsible for the development, implementation, and maintenance of the BlueCard Health Program. This position is responsible for managing operational and reporting relationships with the Blue Cross Blue Shield Association (BCBSA). This role ensures compliance with regulatory and BCBSA mandates, drives cost containment strategies, and oversees performance reporting, audits, and vendor management for Federal Employee Program (FEP) claims.

Key Responsibilities

BlueCard Program Oversight

• Develop, implement, and maintain claims health programs, including provider audit processes.
• Oversee management team to identify cost containment, audit, and recovery opportunities related to provider payments.
• Manage inventory to comply with Blue Cross and regulatory standards.
• Direct staff to ensure accurate, cost-effective benefit administration and timely processing of claims and member inquiries.
• Supervise staff involved in complex claims audits.

BCBSA Operations & Reporting

• Manage BCBSA relationships for operations and reporting, ensuring alignment of internal resources with BlueCard priorities and strategies.
• Participate in business planning and visioning activities; provide timely insight into future plans and coordinate high-level estimation needs.
• Maintain awareness and coordination of business requirements and BCBSA mandates.
• Oversee all BCBSA performance reporting, including LOS/LDLA Home and HOST, Provider Data, Performance Scorecard, and Plan-to-Plan metrics.
• Create and manage communication plans and artifacts to ensure timely implementation of BCBSA mandates.
• Support all BCBSA consultative and mandated audits; collaborate with business teams to implement required changes based on audit results.

FEP Team Leadership

• Lead the FEP team to ensure compliance with claim and audit requirements.
• Oversee vendor performance to meet timeliness and accuracy standards mandated by the Federal Government for claims adjudication.