Blue Cross Blue Shield Association

• Provide strategic leadership and oversight for the specialty pharmacy benefit serving a large federal member population • Lead the overall administration, operational delivery, regulatory compliance, and program performance • Serve as the enterprise owner of the specialty pharmacy benefit strategy for the Federal Employee Program • Build and maintain trusted partnerships with federal program leadership, senior internal stakeholders, and vendor partners • Lead executive program reviews and strategic discussions, presenting insights on program performance, emerging risks, and opportunities for improvement • Provide leadership across clinical, operational, financial, analytics, and PBM teams • Manage high-priority escalations and complex issues • Provide strategic oversight and governance of the specialty pharmacy benefit • Guide the planning, implementation, and continuous improvement of specialty pharmacy benefit programs • Monitor program performance through key operational, clinical, and service metrics • Ensure the specialty pharmacy program operates in full compliance with federal regulations, contractual obligations, and program governance standards • Provide strategic oversight of PBM and specialty pharmacy vendor relationships • Lead cross-functional teams responsible for implementing specialty pharmacy benefit updates, program enhancements, and regulatory changes • Leverage specialty pharmacy claims data, utilization trends, and operational metrics to evaluate program performance

• Design and implement new and enhanced software applications, processes, and systems to support internal & external stakeholders. • Understand Synergie’s business objectives and leverage various coding languages (e.g., SAS, VBA, SQL, Python, Java) to create novel solutions to streamline and automate processes wherever possible. • Facilitate detailed technical discussions with various internal and external stakeholders to establish new and enhanced features to software applications and systems. • Provide technical support to internal and external stakeholders for various components of Synergie’s IT Infrastructure. • Develop and manage ongoing updates to technical documentation and Standard Operating Procedures related to Synergie Applications and Systems. • Other duties as assigned.

• Lead pharmacy supply chain strategy, vendor relationships, operational performance, and pharmacy benefit optimization • Lead negotiations with manufacturers, wholesalers, PSAO's, PBM's, specialty pharmacies, and logistics partners • Develop contracts, pricing structures, SLA's, and performance metrics • Manage vendor performance to ensure service excellence, compliance, and cost optimization • Develop sourcing, contracting, and operational strategies aligned with organizational goals • Collaborate with internal Pharmacy, Clinical, PBM, Finance, and Technology teams to optimize supply chain performance • Create standard implementation playbooks and best practices • Use pharmacy data to identify trends, cost drivers, utilization patterns, and operational opportunities

• Overseeing the organization’s client and pharmaceutical rebate audit function and ensuring the effectiveness of financial, operational, and contractual compliance controls across the enterprise. • Leading the planning and execution of audit programs, identifying risk exposures, and providing actionable recommendations to enhance operational execution, governance, efficiency, and compliance. • Closely working with executive leadership to promote a strong internal control culture and continuous improvement mindset. • Leading and overseeing pharma and client audits for Synergie. • Supporting SOC audit evidence gathering for annual audit. • Evaluating the efficiency and effectiveness of internal controls, processes, and risk management frameworks. • Monitoring corrective action plans, ensuring timely resolution of audit findings. • Developing and executing the annual risk-based audit plan aligned with organizational strategy and regulatory requirements.

• Ensure Plans' operations handle customer interactions accurately and promptly • Execute audit programs and validate reported results • Present updates and recommendations at various events • Contribute to strategic planning by developing materials, presentations, and documentation • Create and improve standard operating procedures for departmental functions • Interact extensively with Plan staff at all levels, requiring diplomacy in difficult conversations • Influence local and national Plan operations • Responsible for overall Plan execution of the Operational Audit Programs • Analyze performance results and lead cross-functional meetings with Plan stakeholders to facilitate the development and completion of action plans for each performance program • Lead in the development and administration of various audit initiatives/programs that impact internal and external stakeholders • Provide Plans education and support by helping them to understand and properly execute operational and audit requirements in both formal and informal settings

The role ensure Plans' operations handle customer interactions accurately and promptly, leaving a positive brand impression. Execute audit programs and validate reported results. Present updates and recommendations at various events. Contribute to strategic planning by developing materials, presentations, and documentation. Create and improve standard operating procedures for departmental functions. Interact extensively with Plan staff at all levels, requiring diplomacy in difficult conversations. Influence local and national Plan operations. Responsible for overall Plan execution of the Operational Audit Programs. This includes auditing Plans’ local and inter-Plan claim processing, local customer service processing, and enrollment processing in accordance with applicable program. Analyze performance results and lead cross-functional meetings with Plan stakeholders in order to facilitate the development and completion of action plans for each performance program. Lead in the development and administration of various audit initiatives/programs that impact internal and external stakeholders. Provide Plans education and support by helping them to understand and properly execute operational and audit requirements in both formal and informal settings on a scheduled or ad-hoc basis. This includes providing face-to-face training, webinars, handling the Help Desk, one-on-one meetings, and collaborating with other BCBSA staff. Qualifications Education Required Bachelor's Degree in a business-related discipline or equivalent work experience Experience 5+ Years related work experience Required Knowledge Skills and Abilities Ability to manage and adapt to multiple, changing priorities. Demonstrated proficiency in the Microsoft Office suite and Internet technologies. Demonstrated research and analytical skills (quantitative and qualitative). Demonstrated presentation and communication skills both oral and written. Knowledge of BlueCross Blue Shield and Inter-Plan Programs. #LI-Remote The posted salary range is the lowest to highest salary we , in good faith , believe we would pay for this role at the time of this posting . We may ultimately pay more or less than the hiring range and t his hiring range may also be modified in the future. A candidate’s position within the hiring range may be based on several factors including, but not limited to, specific competencies, relevant education, qualifications, certifications, relevant experience, skills, seniority, performance, shift, travel requirements, and business or organizational needs. This job is also eligible for annual bonus incentive pay. We offer a comprehensive package of benefits including paid time off, 11 holidays, medical/dental/vision insurance, generous 401(k) matching , lifestyle spending account and m any other benefits to eligible employees. Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.