This position is responsible for ensuring the FEP Program remains compliant with the CS 1039 Contract, Procurement & all regulatory requirements. Responsible for the oversight of the FEP Director’s Office Plan Incentive Program (PIP), the OPM Quality Assurance Program (QAP) and to ensure a positive FEP member experience that meets or exceeds expectations. The position works cross-functionally within the Plan to ensure all components of the Program are aligned with FEP initiatives, system release changes, NextGen and Clinical Pilots, the annual Business Plan and Budget Process including monitoring of Administrative and Benefit costs as well HEDIS & CAHPS measures. This position is also directly accountable for all components of claim/adjustment processing & member/provider service including Correspondence. The position serves as the liaison between the FEP Directors Office and the FEP Operations Center as it relates to Capital BlueCross FEP business.

• Responsible for core operations (claims/customer service) for the Federal Employee Health Benefit Program (FEHBP). This includes the management of the business consultants, analysts, manager, supervisors, and processing staff associated with supporting the FEP Programs. Directs, leads, and oversees staff in accomplishing work objectives within the unit(s). Coaches, motivates, rewards, and recognizes employees. Sets clear goals, objectives and performance expectations and holds employees accountable for achieving results.
• Responsible for collaborating with internal areas, throughout the organization, regarding performance and responsiveness to ongoing and ad hoc activities for the FEP Directors Office, FEP Operations Center & the Office Of Personnel Management (OPM) Call Letter directives.
• Engage in and coordinate operational testing for the four quarterly system releases, including additional planned minor and warranty releases. Comply with the certification of project milestones, understand the enhancements associated with the new functionality and how the changes may improve our corporate delivery of the FEP Program.
• Communicate FEP projects, workgroups, enhancements and assignments to various internal Capital BlueCross departments. Ensure the correct audience participates in the various initiatives, and our Plan’s concerns are communicated to the BCBSA in a timely manner.
• Coordinate the annual Corporate and FEP Budget and Business Plan. Identify cost savings opportunities, and track the budget variances in relation to Administrative PMPM and Benefit Costs.
• Support the Sales team as needed in ensuring continued membership growth in both Programs.

Skills:

• Ability to develop, coordinate, manage, guide and consult with various internal and external entities. Innovative thinking is also an asset, due to the ever changing Insurance Industry.
• People management skills required, related to both direct reports and to building relationships throughout Capital Blue Cross, with other Blues Plans, and with the FEP Director’s Office/Operations Center.

Knowledge:

• Thorough knowledge of the FEHBP Program, including PIP & QAP Performance Programs, FEP release concepts, NextGen Project, FEPDO and OIG Audits, Procurement, Reporting, Annual Business Plan. Basic knowledge of operational concepts to ensure all performance objectives are met.

Experience:

• 7 years of operational experience in health insurance, and prefer FEP Program knowledge.
• 3 years staff, team lead or project lead experience.

Education and Certifications:

• Bachelor’s degree preferred.

Work Environment:

Desk work, minimal lifting & virtual meetings.

Physical Demands:

While performing the duties of the job, the employee is frequently required to sit, use hands and fingers, talk, hear, and see. The employee must be able to work over 40 hours per week. The employee must occasionally lift and/or move up to 5 pounds.

Other:

• Number of direct and indirect reports: 6 - 7 direct reports; up to 25 indirect reports.
• Work Environment: Desk work, minimal lifting & virtual meetings.

We recognize that work is a part of life, not separate from it, and foster a flexible environment where your health and wellbeing are prioritized. At Capital you will work alongside a caring team of supportive colleagues and be encouraged to volunteer in your community.  We value your professional and personal growth by investing heavily in training and continuing education, so you have the tools to do your best as you develop your career. And by doing your best, you’ll help us live our mission of improving the health and well-being of our members and the communities in which they live.