Blue Cross Blue Shield of Massachusetts

Manager

• Directs the utilization review clinical team operations for our Commercial plans
• Provide decisive leadership and direct supervision to a clinical staff team, including subordinate leaders and their teams.
• Execute a forward-thinking utilization management strategy that aligns with the company's goals.
• Lead performance management, including hiring, professional development, mentorship, and performance evaluations to build a high-performing, engaged team.
• Foster a culture of clinical excellence, empathy, and member-centered care.
• Direct all utilization review functions, including pre-service, concurrent, and retrospective reviews, ensuring timeliness and adherence to evidence-based medical necessity criteria and internal medical policies.
• Analyze complex utilization data to identify trends, patterns, and opportunities for clinical quality improvement.

Senior Manager, Clinical Review

Financial Planning and Analysis

• Identifying and interpreting payment trends and making recommendations
• Interacting with key internal and external customers to ensure financial strength
• Managing a comprehensive book of business comprised of varying financial arrangements
• Demonstrating accounting skills in completing periodic settlements, processing journal entries, and providing billed versus paid audits as required
• Maximizing cash flow, minimizing bad debt, and negotiating payment plans

Customer Financial Management Specialist

Account Executive

• Spearheads renewal and cross-selling initiatives for a dedicated portfolio of national clients
• Architects and implements customized strategies that align national client business objectives with BCBSMA's comprehensive suite of solutions
• Strategically engages and manages relationships with key internal and external stakeholders
• Embodies and promotes the core values of BCBSMA
• Serves as a dedicated advocate for national account clients and their members

National Account Executive IV

• Collaboration with Application Development, Infrastructure, and 3rd party vendors to ensure the delivery of the Infrastructure Programs enables both current and future business needs
• Communicate effectively with internal colleagues as well as IT management to set clear expectations from a timeline, functionality, and service delivery perspective.
• Routinely assess infrastructure programs and recommend ideas for continuous improvement and/or automation opportunities
• Identify and baseline Key Performance Indicators (KPIs) for critical infrastructure programs
• Act as a liaison between infrastructure technology partners/vendors and other business areas
• Manage complex technical issues and projects with insourced, outsourced, and 3rd party teams.
• Deliver Audit/Compliance responses in a thoughtful, strategic, and articulate manner
• Ability to manage multiple Infrastructure Programs with a continuous learning mindset
• Foster strong working and interpersonal relationships.
• Solid foundational knowledge of IT: Systems, Network, Desktop Cloud, Databases, App/Dev, etc.

Lead Infrastructure Engagement Manager

• Provide strategic direction and oversight for the development of innovative contracting models, financial arrangements, and provider partnerships that support enterprise goals.
• Manage risk, enhance BCBSMA’s competitive position, and serve as a trusted advisor to internal stakeholders.
• Drive cross-functional initiatives and provide people and thought leadership within the Contract Operations function.
• Set strategic direction and lead the development and implementation of innovative contracting methodologies for physician and institutional providers.
• Provide oversight of contract amendments, renewals, and approvals, ensuring compliance with business, legal, and financial requirements.
• Assess and mitigate financial, operational, and contractual risk while ensuring contracts support long-term strategic and financial objectives.
• Lead high-impact, cross-functional project teams and influence decision-making without direct authority.
• Partner with Operations and Technology teams to ensure accurate and timely implementation of contracts within the Provider Contract Management System (e.g., Salesforce).

Senior Manager, Contract Development

Product Manager

• Partner with Engineering, Testing, and Architecture teams to prioritize, decompose, groom, and schedule work items (epics and stories)
• Partner with enterprise stakeholders to prioritize portfolio initiatives and maintain roadmaps driving the shared product vision
• Attend or lead Agile Scrum and Kanban ceremonies including daily stand ups, sprint planning, sprint grooming, sprint retrospectives, sprint demo, and PI sessions
• Manage communications between and within Values Stream, ET Shared Services, and Technical Delivery teams
• Understand and manage upstream and downstream impacts associated with changes or enhancements to core data assets
• Engage and activate technical and shared services teams to maintain momentum and support end to end development and implementation activities
• Administer Enterprise Data Architecture aligning with your data domain including balance and control, audit, data dictionary, and data sharing activities
• Maintain current knowledge of relevant healthcare and consumer technology trends, competitors, and market offerings

Senior Product Owner

Sales

• Serve as a primary partner to the New Business Sales team in managing large and complex RFPs from intake through submission.
• Review, scrub, and assess incoming RFPs for requirements, timelines, and internal dependencies.
• Submit RFPs internally and coordinate responses across multiple internal partners, including: Proposal Development Services, Underwriting, Product Network, Clinical, and other subject matter experts as needed.
• Support the sales team in developing, managing, and maintaining a strong and accurate new business pipeline within Salesforce.com.
• Track opportunities, key milestones, deadlines, and follow-up actions.
• Partner with Sales to ensure CRM data integrity, reporting accuracy, and visibility into pipeline health.
• Act as a central point of coordination between Sales and internal teams to drive alignment and execution.
• Communicate clearly and professionally with internal stakeholders to manage expectations and timelines.
• Build strong working relationships across departments to facilitate efficient information flow.
• Identify opportunities to improve RFP workflows, communication, and efficiency.
• Contribute to best practices, tools, and documentation to support scalable growth.
• Proactively anticipate needs and remove friction for the sales team wherever possible.