Blue Cross Blue Shield Association

Compliance

• Provide strategic direction and oversight for corporate compliance and privacy programs
• Ensure alignment with evolving healthcare regulations, industry standards, and internal policies
• Advise executive leadership, the Board of Directors, and governance committees
• Serve as the designated Privacy Official and oversee HIPAA compliance for BCBSA
• Develop and implement privacy policies, procedures, personnel training, and complaint investigation processes
• Serve as BCBSA’s Medicare Compliance Official and subject matter expert for Medicare Part D and other government programs compliance
• Build and oversee government programs compliance operations
• Support and oversee Compliance Committee operations and report findings to leadership and governance committees
• Serve as BCBSA’s Compliance Official
• Lead and provide operational oversight for the Compliance and Ethics Program, including the Code of Business Conduct and annual reporting
• Address compliance issues with internal stakeholders
• Oversee the Privacy Program, including HIPAA and GDPR compliance
• Lead cross-functional investigation and resolution of privacy incidents
• Lead and develop the compliance and privacy team
• Promote best practices and coordinate incident response efforts across the system
• Oversee compliance and ethics training programs for Blue Plan Compliance leaders

Senior Director, Compliance and Privacy

Head of Department

• Serve as the primary programmatic owner and operational lead for the Medicare Performance Hub
• Drive performance improvement in Star Ratings, Risk Adjustment, and Medical Cost Management
• Oversee the Hub’s build-out, operationalization, and ongoing governance
• Translate national program data and analytic insights into targeted guidance for Plans
• Identify benchmarks and performance targets across Stars, Risk Adjustment, and Medical Cost Management
• Monitor performance in real time where possible and identify gaps and remediation pathways
• Deliver member-level insights to Plans through dashboards and consultative engagement
• Coordinate with analytics platform partners, BHI, and BCBSA clinical and analytic staff
• Establish governance, escalation pathways, corrective action plans, and Plan performance incentive frameworks
• Own the MPH analytics platform vendor relationship and accountability for program and Plan-level deliverables
• Build dashboards with national, regional, Plan, provider, geography, and member-level views
• Develop benchmark and target-setting methodology for the Plan Performance Incentive Program
• Oversee integration of claims, clinical supplemental data, encounters, and Risk Adjustment Files
• Manage MPH data access and licensing strategy for Plans
• Lead design, implementation, operating model, and governance of the Medicare Performance Hub
• Establish operational reviews, reporting cadences, best-practice sharing, and escalation/remediation protocols
• Engage Plan CEOs, senior management, Board of Managers and Directors, CFOs, Government Business Leaders, FEP leads, and clinical and analytic staff
• Translate national insights into Plan-specific action plans and facilitate performance improvement strategies
• Monitor Stars performance, develop Stars analytics, and support HEDIS, administrative, and Part D measure improvement
• Develop risk adjustment analytics covering encounter submissions, chart review, HRA performance, coding opportunities, supplemental clinical data, and RAF trends
• Lead medical cost management analytics covering readmissions, ED utilization, high-cost claimants, inpatient and post-acute utilization, and other cost drivers
• Develop and maintain the medical cost performance playbook
• Partner with Plans on cost trends, root causes, targeted interventions, and local vendor engagement
• Define MPH data requirements and represent MPH needs in data architecture decisions
• Ensure analytics requirements align with MA data repository architecture and Plan submission standards
• Coordinate with Legal, Compliance, and Actuarial functions to align operations, data sharing, and incentives with CMS regulations, BCBSA policy, and the PPA

Senior Director, Compliance and Privacy

Head of Medicare Performance Hub