Legal Counsel Litigation
Blue Cross Blue Shield
Washington, DC, Washington, DC
legal
counsel
litigation
legal
litigation
counsel
brand
subpoenas
healthcare
education
fraud
special investigations
team
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January 21, 2023
Blue Cross Blue Shield
Washington, DC, Washington, DC
FULL_TIME
Job Description Summary
The Legal Counsel – Litigation is responsible for assisting on all BCBSA litigation activities. These activities include: assisting the Federal Employee Program’s (FEP) litigation efforts, coordinating with the BCBSA National Anti-Fraud Department (NAFD), FEP Special Investigations Unit (SIU) and Blue Cross Blue Shield (BCBS) Plan SIUs in fraud/waste/abuse related matters and recovery actions, coordinating with the Brand Legal team on litigation related to Brand misuse, managing BCBSA affirmative recovery matters (insurance and indemnification claims), and responding to subpoenas, discovery requests and governmental and regulatory requests for information in BCBSA litigation matters.
The Legal Counsel - Litigation will also assist BCBSA's Legal Department Cooperative (LDC) in preparing the Legal Messenger update on important legal developments relating to healthcare payors and assisting in LDC activities relating to continuing legal education, prepare the Legal Affairs Bulletin of significant healthcare payor-related cases on a quarterly basis and provide other support to the BCBSA Legal Department.
Responsibilities include but are not limited to:
- Federal Employee Program Litigation – Direct FEP civil recovery efforts by reviewing SIU FWA reports to identify potential recovery opportunities. Direct investigation efforts to develop factual details and evidence for claims that FEP pursues. Retain and manage outside counsel to pursue civil recovery actions and take action to pursue claims via in-house efforts where appropriate. Make strategic decisions on the direction and resolution of civil recovery actions. Work with FEP pharmacy, claims, and NAFD FEP SIU staff and vendors to collect data necessary to support FEP FWA claims and pharmacy class action and antitrust claims. Provide reports to FEP stakeholders on litigation matters, civil recovery efforts and value produced.
- BCBSA Recovery Efforts – Identify class actions and bankruptcies in which BCBSA has a financial stake and make appropriate claims to collect. Assist the Assistant General Counsel – Litigation with indemnification and insurance claims and issues.
- Special Investigations Unit and Legal Department Support – Assist the NAFD/SIU and Legal Department periodically on other matters that arise such as responding to grand jury subpoenas for criminal investigations and supporting other BCBSA litigation as needed.
- Brand Misuse Enforcement and Recovery – Work with the Brand team to identify, support and manage cases in which the BCBS Brands have been misused to generate revenue for non-BCBS Licensees using the BCBS Brands to obtain injunctive relief and damages.
- Subpoena/Discovery Response - Prepare responses and objections to subpoenas, discovery requests and requests for information from governments and regulatory agencies.
- LDC activities - Assist BCBSA's Legal Department Cooperative (LDC) in preparing the Legal Messenger update on important legal developments relating to healthcare payors and assisting in LDC activities relating to continuing legal education, prepare the Legal Affairs Bulletin of significant healthcare payor-related cases on a quarterly basis and provide legal research and other support to the BCBSA Legal Department.
Required Education, Certifications and Experience
- Juris Doctorate
- Admission to any state (or the District of Columbia) bar
- This position requires basic knowledge of civil litigation practice and procedure necessary to respond to subpoenas, discovery and other requests and identify, understand and brief significant cases for the LDC. Success will depend on significant pragmatism and sound business judgment, as the Associate General Counsel will be expected to identify FWA cases to pursue that are both legally meritorious and worth pursuing financially. Strong organizational and management skills are also required as the position requires the Associate General Counsel to manage multiple matters and assume different responsibilities across different areas of the Legal Department. In addition, the position is highly collaborative, as the Associate General Counsel will need to work extensively with the BCBSA NAFD and Plan SIUs and counsel, outside counsel and many BCBSA stakeholders and colleagues
Preferred Education, Certifications and Experience
- This is an entry-level position in BCBSA's Legal Department. Experience with civil or criminal litigation in a law firm or government is preferred but not required.
People Management – No
The Legal Counsel – Litigation is responsible for assisting on all BCBSA litigation activities. These activities include: assisting the Federal Employee Program’s (FEP) litigation efforts, coordinating with the BCBSA National Anti-Fraud Department (NAFD), FEP Special Investigations Unit (SIU) and Blue Cross Blue Shield (BCBS) Plan SIUs in fraud/waste/abuse related matters and recovery actions, coordinating with the Brand Legal team on litigation related to Brand misuse, managing BCBSA affirmative recovery matters (insurance and indemnification claims), and responding to subpoenas, discovery requests and governmental and regulatory requests for information in BCBSA litigation matters.
The Legal Counsel - Litigation will also assist BCBSA's Legal Department Cooperative (LDC) in preparing the Legal Messenger update on important legal developments relating to healthcare payors and assisting in LDC activities relating to continuing legal education, prepare the Legal Affairs Bulletin of significant healthcare payor-related cases on a quarterly basis and provide other support to the BCBSA Legal Department.
Responsibilities include but are not limited to:
- Federal Employee Program Litigation – Direct FEP civil recovery efforts by reviewing SIU FWA reports to identify potential recovery opportunities. Direct investigation efforts to develop factual details and evidence for claims that FEP pursues. Retain and manage outside counsel to pursue civil recovery actions and take action to pursue claims via in-house efforts where appropriate. Make strategic decisions on the direction and resolution of civil recovery actions. Work with FEP pharmacy, claims, and NAFD FEP SIU staff and vendors to collect data necessary to support FEP FWA claims and pharmacy class action and antitrust claims. Provide reports to FEP stakeholders on litigation matters, civil recovery efforts and value produced.
- BCBSA Recovery Efforts – Identify class actions and bankruptcies in which BCBSA has a financial stake and make appropriate claims to collect. Assist the Assistant General Counsel – Litigation with indemnification and insurance claims and issues.
- Special Investigations Unit and Legal Department Support – Assist the NAFD/SIU and Legal Department periodically on other matters that arise such as responding to grand jury subpoenas for criminal investigations and supporting other BCBSA litigation as needed.
- Brand Misuse Enforcement and Recovery – Work with the Brand team to identify, support and manage cases in which the BCBS Brands have been misused to generate revenue for non-BCBS Licensees using the BCBS Brands to obtain injunctive relief and damages.
- Subpoena/Discovery Response - Prepare responses and objections to subpoenas, discovery requests and requests for information from governments and regulatory agencies.
- LDC activities - Assist BCBSA's Legal Department Cooperative (LDC) in preparing the Legal Messenger update on important legal developments relating to healthcare payors and assisting in LDC activities relating to continuing legal education, prepare the Legal Affairs Bulletin of significant healthcare payor-related cases on a quarterly basis and provide legal research and other support to the BCBSA Legal Department.
Required Education, Certifications and Experience
- Juris Doctorate
- Admission to any state (or the District of Columbia) bar
- This position requires basic knowledge of civil litigation practice and procedure necessary to respond to subpoenas, discovery and other requests and identify, understand and brief significant cases for the LDC. Success will depend on significant pragmatism and sound business judgment, as the Associate General Counsel will be expected to identify FWA cases to pursue that are both legally meritorious and worth pursuing financially. Strong organizational and management skills are also required as the position requires the Associate General Counsel to manage multiple matters and assume different responsibilities across different areas of the Legal Department. In addition, the position is highly collaborative, as the Associate General Counsel will need to work extensively with the BCBSA NAFD and Plan SIUs and counsel, outside counsel and many BCBSA stakeholders and colleagues
Preferred Education, Certifications and Experience
- This is an entry-level position in BCBSA's Legal Department. Experience with civil or criminal litigation in a law firm or government is preferred but not required.
People Management – No
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