Job Description

Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy. AZ Blue offers a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.

At AZ Blue, we have a hybrid workforce strategy, called Workability, that offers flexibility with how and where employees work. Our positions are classified as hybrid, onsite or remote. While the majority of our employees are hybrid, the following classifications drive our current minimum onsite requirements:

• Hybrid People Leaders: must reside in AZ, required to be onsite at least twice per week
• Hybrid Individual Contributors: must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per week
• Hybrid 2 (Operational Roles such as but not limited to: Customer Service, Claims Processors, and Correspondence positions): must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per month
• Onsite: daily onsite requirement based on the essential functions of the job
• Remote: not held to onsite requirements, however, leadership can request presence onsite for business reasons including but not limited to staff meetings, one-on-ones, training, and team building

Please note that onsite requirements may change in the future, based on business need, and job responsibilities. Most employees should expect onsite requirements and at a minimum of once per week.

Purpose of the job

Responsible for providing strategic, technical, and business leadership in support of the InterPlan Executive and BCBSA Mandates Governance function. Serves as the InterPlan Executive Alternate, as assigned, and represents AZ Blue with BCBSA and Partner Blue Plans. Leads mandate impact assessment and implementation governance, policy interpretation, exception strategy, remediation oversight, and resolution of complex cross-plan escalations. Collaborates with business and segment leaders across Individual, Group, Self-Funded, and Government programs to develop and monitor measures of success, remove barriers, and ensure Association and business commitments are achieved.

REQUIRED QUALIFICATIONS

Required Work Experience

• 6 years of experience in healthcare, including complex operational, regulatory, compliance, governance, or cross-functional programs (Manager).
• 8 years of experience in healthcare, including leadership of complex enterprise-wide operational, regulatory, compliance, governance, or cross-functional programs (Senior Manager).
• 5 years of management or program leadership experience, including major project development (Manager).
• 7 years of management or program leadership experience, including major project development and enterprise-level initiatives (Senior Manager).

Required Education

• Bachelor's degree in business, healthcare administration, finance, or related field, or equivalent experience (both levels).

Required Licenses

• N/A

Required Certifications

• N/A

PREFERRED QUALIFICATIONS

Preferred Work Experience

• Experience with BCBSA mandates, standards, InterPlan programs, or BlueCard operations.
• Experience interpreting and operationalizing regulatory, association, or enterprise policy.
• Experience leading complex programs involving multiple internal and external stakeholders, including executive-level partners.
• Business, financial, or operational control mapping; auditing; or Enterprise Risk Management experience.
• Experience in healthcare operations, sales, marketing, or product development.
• 5 years of experience in tactical compliance execution, such as Corporate Compliance or Medicare/Medicaid Compliance (both levels).

Preferred Education

• Master's degree in business, healthcare administration, or related field.

Preferred Licenses

• N/A

Preferred Certifications

• Project Management Professional (PMP) or equivalent certification.

ESSENTIAL job functions AND RESPONSIBILITIES

MANAGER – SPECIFIC RESPONSIBILITIES

• Independently lead assigned mandate portfolios, policy questions, exception requests, remediation activities, and escalations under the general direction of the InterPlan Executive.
• Lead complex cross-functional initiatives and governance discussions with limited oversight and recommend decisions based on policy, operational impact, risk, and supporting data.
• Serve as the primary point of coordination for assigned BCBSA and Partner Blue Plan matters and ensure required artifacts, commitments, and decisions remain current and visible.
• Coach specialists and contributors supporting assigned work and provide leadership with input regarding workload, capability needs, and development opportunities.

SENIOR MANAGER – SPECIFIC RESPONSIBILITIES

• Perform all responsibilities of the Manager level and lead the most complex, high-risk, or enterprise-wide mandate portfolios and remediation programs.
• Represent AZ Blue in the most significant BCBSA forums and Partner Blue Plan engagements, including matters requiring enterprise positions, negotiation, or executive escalation.
• Partner with the InterPlan Executive to shape long-range Mandates Governance strategy, priorities, operating model, measures, and executive decision cadence.
• Provide functional guidance and mentoring to InterPlan Managers and Governance Specialists; establish consistent practices and elevate capability across the function.
• Synthesize enterprise trends, risks, and policy developments into strategic recommendations for senior and executive leadership.

BOTH LEVELS

• Serve as the InterPlan Executive Alternate as assigned; represent AZ Blue in BCBSA committees, workgroups, and policy forums; and advocate for enterprise needs when proposed requirements create material concerns.
• Lead evaluation and impact assessment of new or revised BCBSA mandates; determine applicability, impacted business areas, implementation approach, dependencies, and decision needs.
• Plan, direct, and manage complex mandate initiatives within prescribed time frames and funding parameters; define scope, objectives, schedules, resource and budget needs, dependencies, risks, and status reporting.
• Partner with project management, product owners, business leaders, technology teams, vendors, and subject-matter experts to execute mandates and resolve barriers.
• Analyze ambiguous or conflicting BCBSA requirements; issue written interpretations and guidance; consult BCBSA when enterprise interpretation is insufficient; and promote consistent application.
• Review compliance-driven process, system, product, and document changes against policy intent; identify conflicts among Association requirements, enterprise policy, and local practice; and drive resolution.
• Evaluate the rationale, risk, and enterprise impact of exception requests; determine whether and how to advance requests; coordinate submission to BCBSA; and manage review, negotiation, conditions, and closure.
• Coordinate with Partner Blue Plan InterPlan Executives and BCBSA on complex claims, member, operational, and system escalations; assess trends and root causes; and drive corrective action.
• Monitor performance against BCBSA standards and commitments; evaluate corrective-action and mitigation plans; assess business and compliance risk; and escalate unresolved risks.
• Prepare executive briefings, positions, recommendations, presentations, dashboards, and talking points; facilitate governance reviews and maintain current decisions, commitments, risks, and performance measures.
• Provide day-to-day guidance, coaching, and knowledge transfer to InterPlan Governance Specialists and cross-functional partners.
• Identify opportunities to improve the governance operating model using appropriate project-management, process-improvement, and agile practices.
• Perform other duties as assigned.
• Each progressive level includes the ability to perform the essential functions of the lower level.
• The position requires a full-time work schedule of at least 40 hours per week, plus additional hours as requested or needed to meet business requirements.

REQUIRED COMPETENCIES

Required Job Skills (All Levels)

• Expert written and verbal communication skills, including executive-level presentations and concise decision materials.
• Advanced PC proficiency and advanced skill in word-processing, presentation, spreadsheet, collaboration, and departmental BCBSAZ/BCBSA applications.
• Ability to create and maintain project plans, schedules, RAID logs, governance artifacts, dashboards, status reports, and decision documentation.

Required Professional Competencies (All Levels)

• Strong knowledge of BCBSA policies, standards, mandates, and InterPlan program requirements, or the ability to rapidly develop and apply that knowledge.
• Strategic analysis and sound judgment using data, policy, risk, and operational impact to support timely recommendations and decisions.
• Advanced analytical, problem-solving, issue-resolution, negotiation, and influencing skills.
• Ability to lead cross-functional teams and create alignment without direct authority.
• Knowledge of project management, process improvement, planning, decision-making, and data-analysis methods.
• Ability to manage shifting priorities, assimilate new programs and systems, and sustain existing commitments in a changing environment.
• Strong understanding of healthcare-industry issues and the ability to assess compliance, operational, financial, member, and reputational risk.
• Ability to build productive relationships with executives, business leaders, subject-matter experts, BCBSA, and Partner Blue Plans.

Required Leadership Experience and Competencies

• High standard of performance while pursuing challenging goals (both levels).
• Principled leadership and sound business ethics (both levels).
• Ability to coach, develop, and provide clear direction to contributors and partners (both levels).
• Ability to guide other managers and establish functional consistency across complex work (Senior Manager).

PREFERRED COMPETENCIES

Preferred Job Skills (All Levels)

• Proficiency with MS Project, SharePoint, reporting or dashboarding tools, and approved AI-enabled productivity tools.

Preferred Professional Competencies (All Levels)

• Federal and state mandate experience.
• Corporate Compliance experience.
• Internal audit or regulatory examination experience.

Preferred Leadership Experience and Competencies

• Experience representing an organization in industry associations or external governance bodies.

#LI-AHAZ

Our Commitment

AZ Blue does not discriminate in hiring or employment on the basis of race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected group.

Thank you for your interest in Blue Cross Blue Shield of Arizona. For more information on our company, see azblue.com. If interested in this position, please apply.