Director,PaymentIntegrity

The Director, Payment Integrity serves as BCBSA's enterprise leader for advancing a System-wide payment integrity strategy that strengthens affordability across the Blue Cross Blue Shield System. This role is responsible for scoping, planning, and driving strategic PI initiatives in close partnership with BCBSA business leaders for Commercial Markets, Government Markets, and FEP, as well as BCBS Plan PI and business leaders. The role brings deep subject matter expertise, executive presence, and a solutions-oriented mindset to ensure the Blues remain competitive across all lines of business in their payment integrity capabilities. BlueCard Payment Integrity Program * Serve as the business owner for BCBSA’s effort to integrate payment integrity into BlueCard claims processing a significant and complex initiative spanning strategy through operations. * Lead the scoping and design effort to define what PI within BlueCard needs to look like. * Drive the operationalization strategy, including Plan engagement and change management across the System. * Own the build-out and eventual ongoing management of BlueCard PI operations at BCBSA. National Accounts Payment Integrity * Serve as the accountable leader for ensuring the Blue System meets the payment integrity needs of national accounts, with a focus on hosted PI requirements and performance. * Identify gaps in the current National Account space to develop future state roadmap. * Define and maintain PI capability requirements for BCBS Plans in support of hosted national account business. * Oversee PI reporting for national accounts and ensure Plans are meeting established requirements. * Serve as a thought partner and System navigator when new PI challenges emerge, helping to formulate the Blue System’s response given its unique construct (e.g., developing the System’s approach to audit vendor activity) Government Markets — FEP Medicare Advantage Wrap * Serve as the PI subject matter expert advising Government Markets as i