Job description

Ready to help us transform healthcare? Bring your true colors to blue.

This role is eligible for the following personas: eWorker, Mobile and Resident.

Blue Cross Blue Shield Massachusetts is seeking an experienced litigator to join its fast-paced and collegial in-house legal department. The attorney will support fraud investigations and represent Blue Cross in pursuing recoveries for fraud and improper billing. This attorney will also act as an interface between Blue Cross and outside entities including law enforcement. Further this position will be responsible for overseeing litigation including our class action and affirmative litigation program which involves management of outside counsel relationships. The attorney will also oversee fraud, waste and abuse (FWA) compliance for our Medicare program and respond to compliance and CMS requests and audits. The attorney will provide risk management advice and litigation services to other areas of Blue Cross as needed. This may include representation of Blue Cross in both federal and state courts and in administrative hearings concerning a wide variety of legal claims. The attorney will also interact with other business areas to effectuate corporate goals.

Key Accountabilities:
Act as legal counsel to the Fraud Investigation and Prevention (FIP) Unit providing advice throughout each stage of investigation through to resolution which could include settlement and/or litigation or law enforcement activity
Manage the class action and affirmative litigation program including strategizing matters with outside counsel, overseeing program growth and metrics, and managing the litigation activities
Effectively collaborate with outside counsel in a variety of litigation-related matters
Appear on behalf of Blue Cross in civil and criminal courts and regulatory matters
Represent Blue Cross in interactions with regulatory agencies and in responding to subpoenas or other civil investigatory demands
Work closely with investigators and medical records reviewers with respect to FWA investigations
Oversee work done by the class action and affirmative litigation team relative to case investigation, analysis and litigation, including data production work
Provide pre-litigation and risk management advice to business regarding the creation of controls to manage FWA schemes
Support the Medicare compliance program by overseeing Medicare FWA activity in FIP, work with the Pharmacy Benefit Manager on FWA work, present to the Medicare Compliance Committee and manage requests and audits from CMS
Support company business initiatives by providing guidance and judgment regarding the complex and evolving legal environment
Collaborate with business leaders by effectively communicating complex legal principles to determine relevance to business areas and potential solutions to identified issues
Perform other legal duties based on new opportunities that arise within the Law Department

Qualifications:
Ability to document investigations in a manner appropriate for senior management consideration, litigation and law enforcement action
Excellent presentation skills, including the ability to persuasively present cases to 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 providers in a constructive manner
Skill to solve problems independently along with willingness to work as a team member
Demonstrated experience litigating matters in court and before administrative agencies
Ability to understand and quickly learn new areas of the law and provide counsel and expertise to the business on those areas
Excellent business acumen and judgment, including ability to place legal risk in proper business context
Effective collaboration with key business areas
High degree of professionalism along with ability to influence peers and leaders at all levels
Excellent written and oral communication skills
Strong organizational and prioritization skills; ability to manage multiple priorities effectively
Flexibility and interest in taking on additional work/projects as opportunities arise

Education/Relevant Experience:
BA and JD degrees
Massachusetts license to practice law and member in good standing
Six or more years of complex litigation experience, preferably related to healthcare
Preferred prosecutorial or law enforcement background
Experience with ERISA benefit plans, Medicare and/or health insurance a plus

Minimum Education Requirements:
High school degree or equivalent required unless otherwise noted above

Location Boston Time Type Full time

At Blue Cross Blue Shield of Massachusetts, we believe in wellness and that work/life balance is a key part of associate wellbeing. We provide a flexible hybrid work model in which roles are designated as resident (on site 4-5 days/week), mobile (on site 1-3 days/week), or eworker (on site 0-3 days/month).

Blue Cross Blue Shield of Massachusetts, has a COVID-19 vaccination requirement for building entry. Your offer of employment is dependent upon either being fully vaccinated for COVID-19 or an accommodation based on a disability or sincerely held religious belief, practice, or observance by submitting a request to Human Resources.

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