Senior Consultant - National Markets

This role leads the operational compliance, business performance, and strategic positioning of Highmark’s Commercial Sales Markets in relation to the Blue Cross Blue Shield Association (BCBSA), other Blue Cross Blue Shield (BCBS) Plans, and the Consortium Health Plans (CHP) policies, mandates, and strategic actions. The incumbent serves as Highmark’s designated “National Account Executive” to the BCBSA and acts as Highmark’s ambassador with the BCBSA, other BCBS Plans, and CHP on strategic initiatives. This position supports all Commercial Sales Markets teams and ensures synergy with Finance, Sales Ops, Legal, Product Strategy, Customer Alignment, Provider, Actuary, HM Health Solutions, Health Plan Operations, Government Affairs, and Advanced Analytics.

Responsibilities

• Collaborate with all levels of management and staff across Commercial Sales Markets to propose Blue solutions and consistent messaging, delivering value to internal and external customers. Act as a subject matter expert and trusted advisor on the national delivery of Blue commercial group business, including communicating the value of BCBSA, CHP, and other Blue strategic initiatives.
• Manage cede negotiations and all aspects of BCBSA Inter-Plan Program Policies related to ceding for Pennsylvania and National Sales Markets, mitigating the risk of membership recall by home plans.
• Oversee BCBSA and CHP financial policies for reimbursement of InterPlan fees when Highmark is the Control/Home Plan or Par/Host Plan, working closely with Actuarial, National Business Finance, and InterPlan Sales teams.
• Serve as a subject matter expert witness on InterPlan operations, BCBSA policies, and business practices in national and local court cases involving Highmark and/or BCBSA. Research and articulate relevant information in court, depositions, or assist senior management and legal counsel in preparing for legal matters.
• Maintain strong, credible relationships among BCBS Plan colleagues to manage membership retention and common sales strategies for Host BlueCard enrollment. Provide perspective on care delivery innovation and collaborate with stakeholders to position national Blue narrow networks.
• Review and propose changes or recommendations to Inter-Plan Programs Policy changes impacting BlueCard fees, ceding, and network issues. Present proposals to Highmark representatives on BCBSA governance committees (Market Solutions Committee, Commercial Markets Implementation Subcommittee, National Customer Advisory Council) and to Highmark’s CEO in preparation for Board votes.
• Lead project management tasks for Commercial Sales Markets on strategic initiatives, including shared savings expertise, training teams on BCBS competencies (e.g., Inter-Plan Programs Policies, network access fees), CHP pricing strategies, and other competitive financial levers.
• Support the Senior Vice President of National Markets and the National Markets management team in identifying, defining, and resolving problems impacting national client delivery.
• Represent Highmark on BCBSA and CHP Workgroups, such as the CHP Transfer Pricing Workgroup.
• Perform other duties as assigned or requested.

Requirements

• Bachelor’s degree in Business Administration or Health Care Management, or 6 years of progressive experience in interplan/consultative/cede roles in lieu of a degree.
• 5 years of experience with BCBSA Inter-Plan Programs and Policies related to the national delivery of commercial group business.
• 3 years of experience in a consultative role requiring collaboration with BCBSA and BCBS Plans at all levels of management and staff.
• 3 years of experience in project management, including leading strategic initiatives or negotiating/defending administrative agreements.

Preferred Qualifications

• 3–7 years of experience in a consultative role interfacing with BCBSA and BCBS Plans at all levels of management and staff.

Skills

• Excellent time management and project management skills.
• Ability to prioritize and manage multiple projects.
• Recognized as an expert by all levels of management.
• Willingness to take unpopular positions when required.
• Superior institutional knowledge of BCBSA Inter-Plan Programs, Policies, and BCBSA structure.
• Negotiation experience and understanding of legal terminology.
• Independent thinker and doer.
• Encourages direct debate on critical issues.
• Team-based tactics for critical problem-solving.
• Strong relationships with BCBSA and BCBS Plan staff.
• Broad network within the BCBS system and other Blue Plans.
• Knowledge of Consortium Health Plans’ value and activities.
• Networking skills to develop trust and loyalty among Blue colleagues.

Schedule

• Office-based position.
• Occasional travel (0%–25%) to various work sites or from site-to-site.
• Regularly teaches/trains others.
• Physical work site required.
• Constant lifting up to 10 pounds; rarely lifting 10–25 pounds.

Pay

Base pay range: $118,400.00 – $196,800.00. Compensation is determined by qualifications, experience, expected contributions, internal peer equity, market considerations, and potential geographic differentials for certain locations.