Description

Position Summary

The Manager of BlueCard/Ops Support leads a team of Business Systems Analysts responsible for analyzing operational system automated and manual processes, defining business and technical system strategy, governing platform functionality decisions , and coordinating crossfunctional solution delivery. The role requires highly specialized knowledge of healthcare claims adjudication systems, interplan data exchange protocols, and BlueCard and Federal Employee Program (FEP) system environments. The incumbent serves as the senior technical subject matter expert for BlueCard platform operations, guiding system requirements definition, resolving complex technical issues, directing platform functionality decisions, and ensuring the successful delivery of system enhancements in coordination with BCBSA standards and internal technology teams.

Key Responsibilities

• Lead, develop, and manage a team of Business Systems Analysts responsible for claims system analysis, requirements definition, testing execution, and technical solution support providing expert technical guidance on healthcare claims adjudication logic, data flow design, and BlueCard and FEP platform requirements.
• Oversee project planning activities including scope definition, system integration sequencing, technical dependency mapping, and milestone tracking in partnership with the Program Management Office (PMO).
• Define work assignments, review deliverables, and be accountable for team performance outcomes , ensuring staff technical proficiency and delivery quality across concurrent program workstreams.
• Lead enterprise digital transformation initiatives, including migration of BlueCard ITS platforms to AWS cloud infrastructure supporting platform modernization efforts and governing system design decisions to ensure scalability, performance, and compliance with enterprise standards.
• Manage the full lifecycle of system and business technical updates encompassing requirements definition, test strategy design, validation protocols, and production deployment oversight across multiple claims processing platforms and interrelated system processes simultaneously.
• Lead enterprise and programlevel release management by conducting impact assessments across multiplatform system environments , identifying required system changes and ensuring successful delivery of enhancements across mandatedriven release cycles.
• Oversee system checkout activities during production deployments , coordinate with internal technical, technology and external IT teams to verify functionality, accuracy, and operational readiness, and approving production readiness in coordination with leadership before golive.
• Serve as the senior technical subject matter expert bridging business operations, systems engineering teams, governance bodies, and external platform vendors to resolve complex system issues, integration failures , and data exchange defects.
• Assess system configurations, data exchange implementations, and platform behaviors to verify conformance with BCBSA national program technical standards and FEP system requirements
• Partner with internal departments and external vendors to maintain alignment between system behavior and business requirements translating complex technical findings into clearly defined system changes, ensuring compliance with applicable regulatory and operational standards.
• Lead rootcause analysis and resolution of complex production system issues to implement systemlevel technical corrective actions and ensure platform stability.
• Analyze largescale transaction patterns, exception volumes, and adjudication anomalies to identify systemic risks and drive strategic system improvements

Identify and oversee the implementation of technical improvements to claims adjudication system design including scaled automation solutions, workflow optimization, and performance enhancements across claims adjudication systems.

Required Qualifications

• Bachelor's degree in Computer Science, MIS, Business, Information Technology, Systems Engineering or related field.
• 8+ years of experience in healthcare information technology systems analysis, or technical program management within a health insurance (Payer) environment

• 5+ years of supervisory or team lead experience managing technical teams and enterprise system delivery

• Strong analytical and problemsolving capability with demonstrated ability to translate complex, nonroutine business requirements into precise technical system specifications and process change directives across multiplatform regulated environments.

• Effective communication and documentation skills, with ability to advise organizational leadership and governance forums on program status, technical risk, and system delivery recommendations.

• 5+ years of experience with BlueCard and FEP processing preferred

Preferred Qualifications

• PMP certification

• SAFe Agilist or equivalent Agile certification

Tools & Systems

• Expertise with enterprise healthcare claims adjudication platform , interplan financial data exchange systems , and integrated claims processing solutions.
• Proficiency with workflow governance, requirements lifecycle management, and document control platforms applicable to regulated healthcare IT delivery environments.

• Working knowledge of operational data reporting and analytics platforms for trend analysis, variance reconciliation, and performance monitoring.

• Proficiency with enterprise incident management and ticketing systems for production issue triage, escalation tracking, and resolution with coordination across internal and vendor teams.

• Working knowledge of testing lifecycle and defect management platforms ADO , JIRA.