Senior Associate General Counsel

4 weeks ago

Étreux, Hauts-de-France, United States Blue Cross Blue Shield of Massachusetts Full time
Transforming Healthcare with Expertise

Blue Cross Blue Shield of Massachusetts is seeking an experienced litigator to lead its fraud investigations unit and provide strategic guidance on recoveries for fraud and improper billing. The ideal candidate will oversee the unit's finances, manage a team of senior managers, data analysts, fraud investigators, certified coders, and medical providers, and collaborate with senior business leaders, the Board, and other business units to advance the work of the FIP Unit and support Blue Cross' management of risk related to fraud.

Key Responsibilities:
  • Manage strategy, goal setting, and budget for the FIP Unit, including work on division plans and corporate goals, and presentations to various committees, including Compliance Oversight, Risk Management, and the Audit Committee of the Board.
  • Oversee and act as legal counsel to the FIP Unit, providing advice and guidance throughout each stage of investigation through to resolution, which could include settlement and/or litigation or law enforcement activity.
  • Effectively collaborate with outside counsel in a variety of litigation-related matters and represent BCBSMA in interactions with regulatory agencies and in responding to subpoenas or other civil investigatory demands.
  • Provide pre-litigation and risk management advice to the business regarding the creation of controls to manage fraud, waste, and abuse schemes.
  • Support the Medicare compliance program by overseeing Medicare fraud waste and abuse activity in FIP, working with the Pharmacy Benefit Manager on fraud waste and abuse work, presenting to the Medicare Compliance Committee, and managing requests and audits from CMS.
  • Support the Federal Employee compliance program by overseeing FEP fraud waste and abuse activity in FIP and managing requests and audits with OPM and the Blue Cross Association.
Requirements:
  • Excellent presentation skills, including the ability to persuasively present cases, business matters, and legal advice to the Board, senior management, peer review committees, or government officials.
  • Excellent negotiation skills and experience dealing with opposing counsel and negotiating settlements.
  • Ability to negotiate with and influence different business areas in a constructive manner to achieve division and corporate goals.
  • Demonstrated experience litigating matters in court and before administrative agencies.
  • Ability to understand and quickly learn new areas of the business and the law and provide counsel and expertise to the business on those areas.
  • Excellent business acumen and judgment, including the ability to place legal risk in proper business context.
  • Effective collaboration with key business areas.
  • High degree of professionalism along with the ability to influence peers and leaders at all levels, both within Blue Cross and external to Blue Cross.
  • Excellent written and oral communication skills.
  • Strong organizational and prioritization skills, including the ability to manage multiple priorities effectively.
  • Flexibility and interest in taking on additional work/projects as opportunities or need arise.

Blue Cross Blue Shield of Massachusetts is an equal opportunity employer and welcomes applications from diverse candidates. We offer a comprehensive package of benefits, including paid time off, medical/dental/vision insurance, 401(k), and a suite of well-being benefits to eligible employees. If you are a motivated and experienced litigator looking to join a dynamic team, please submit your application.

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