Assistant General Counsel – Blue Cross Blue Shield Massachusetts

Position Summary:

This position serves as the primary litigator for the Fraud Investigation & Prevention (“FIP”) Unit with respect to all fraud, waste and abuse matters. The Assistant General Counsel will represent Blue Cross Blue Shield Massachusetts (BCBSMA) to pursue recoveries for fraud or improper billing and to act as the interface between BCBSMA and outside entities including law enforcement. This individual also provides litigation services to other areas of BCBSMA on a wide variety of legal claims. This may include representation of the Company in both federal and state courts and in administrative hearings.. The individual also is expected to guide and counsel different business units on new initiatives.

Note: This position will be located in our new corporate headquarters, 101 Huntington Avenue, Boston

 

Key Accountabilities:

• Act as legal counsel to the FIP Unit providing advice throughout the investigatory and resolution stages, and leading recovery activities, including through litigation where necessary, with respect to all allegations of fraud, waste and abuse

• Handle complex litigation matters including claims related to the denial of benefits, provider reimbursement issues, and coordination of benefits
• Effectively collaborate with outside counsel in a variety of litigation-related matters.

• Appear on behalf of BCBSMA in federal and state courts
• Represent BCBSMA in interactions with regulatory agencies and in responding to subpoenas or other civil investigatory demands
• Indirectly supervise investigators and medical records reviewers with respect to investigations pertaining to fraud, waste and abuse
• Collaborate with business leaders by effectively communicating complex legal principles to determine relevance to business areas and potential solutions to identified issues

 

 

Qualifications: .

 

• Ability to document investigations in a manner appropriate for senior management
• Excellent presentation skills, including the ability to persuasively present cases to senior management, peer review committees or government officials
• Excellent interviewing skills with extensive interviewing experience
• Ability to negotiate with and influence providers in a mature and constructive manner

• Skill to solve problems independently accompanied by willingness to work as a team member

• Demonstrated experience litigating matters in court and before administrative agencies

 

• Excellent business acumen and judgment, including ability to place legal risk in proper business context
• Effective collaboration with key business areas

 

Education/Relevant Experience:

• BA and JD degrees
• Massachusetts license to practice law

Six or more years of complex litigation experience, preferably related to healthcare Prosecutorial or law enforcement background a plus

 

#LI-LH1

 

Please apply online using the link below:

 

https://sjobs.brassring.com/TGWEbHost/jobdetails.aspx?partnerid=25692&siteid=5387&AReq=651BR