Lead Generalist, Medicare Administration (Remote)

Lensa; Akron (OH); Remote; USD 77,000 - 142,000; Full time

Job summary

A leading company in healthcare is seeking a skilled professional to manage Medicare products. The role involves ensuring compliance, improving processes, and collaborating across business units. Candidates should have extensive experience in managed healthcare and strong analytical skills. Competitive salary offered based on experience and location.

Benefits

Competitive Benefits

Qualifications

• 7+ years in managed healthcare, experience with MMP - Medicare-Medicaid plans.
• Ability to identify and implement operational process improvements.

Responsibilities

• Manage benefits, operations, communication, reporting, and data exchange for Medicare products.
• Ensure operational compliance with federal regulations.

Skills

Health Plan Operations

Analytical Skills

Operational Process Improvements

Education

BA/BS

Job description

Manage benefits, operations, communication, reporting, and data exchange for Medicare products in alignment with strategic and corporate goals. Develop infrastructure, standards, policies, and procedures for Medicare and Dual Eligible programs. Ensure operational compliance with federal regulations. Collaborate across business units to support Medicare and Dual Eligible operations with effective, accurate, and efficient processes. Define, communicate, and configure benefits; ensure all member communications are compliant; and guarantee data exchanges and reports meet federal requirements.

Knowledge/Skills/Abilities

Expertise in health plan operations, Medicare, and MMP program requirements. Recognized as a department SME and leader. Ability to identify and implement operational process improvements. Support Medicare-Medicaid plans on member retention, performance, reporting, and acquisition. Assist department leaders on sales, compliance, analytics, strategy, and policy. Develop Medicare Advantage analytic reports.

Job Qualifications

Required Education: BA/BS or equivalent experience of 7+ years in healthcare or related field.

Required Experience: 7+ years in managed healthcare, experience with MMP - Medicare-Medicaid plans, strong analytical skills.

Interested current Molina employees should apply via the intranet. Molina offers competitive benefits and is an EOE. Pay range: $77,969 - $141,371 annually. Actual pay varies based on location, experience, education, and skills.