Lead Generalist, Medicare Administration (Remote)

Molina Healthcare; City of Albany (NY); Remote; USD 77,000 - 142,000; Full time

Job summary

An established industry player is seeking a dynamic leader to manage Medicare operations and product development. This role involves overseeing benefits, compliance, and data reporting while ensuring operational excellence in a fast-paced environment. The ideal candidate will leverage their extensive experience in managed healthcare to drive process improvements and support strategic initiatives. Join a forward-thinking organization that values innovation and collaboration, offering a competitive compensation package and the opportunity to make a significant impact in the healthcare sector.

Qualifications

• BA/BS degree or 7+ years of relevant experience in Healthcare.
• Strong quantitative and analytical skills required.

Responsibilities

• Manage benefits, operations, and data exchange of the Medicare product.
• Ensure operational compliance and adherence to federal regulations.

Skills

Health Plan Operations

Operational Process Improvements

Quantitative Skills

Analytical Skills

Medicare-Medicaid Plans

Education

BA/BS degree

7+ years of relevant experience

Job description

Job Description

Job Summary

Responsible for managing the benefits, operations, communication, reporting, and data exchange of the Medicare product in support of strategic and corporate business objectives. Develops infrastructure, standards, policies, and procedures for the Medicare and Dual Eligible Program. Participates in the strategic development of its products and services. Ensures operational compliance and adherence to federal regulations. Collaborates with business and operational units to support Medicare and Dual Eligible operations through effective, accurate, and efficient processes. Benefits are clearly defined, communicated, and configured; member communications are compliant; and data exchanges and reports are accurate, timely, and meet federal requirements.

Knowledge/Skills/Abilities

• Demonstrates superior SME on health plan operations and Medicare and MMP program requirements, recognized as a department leader.
• Assists functional business owners in identifying and implementing operational process improvements.
• Supports Medicare-Medicaid plans on member retention, performance optimization, MMP reporting, and new member acquisition.
• Supports department leaders on sales, compliance, analytics, strategy, and policy initiatives.
• Develops Medicare Advantage analytic reports.

Job Qualifications

Required Education

BA/BS degree or minimum of 7+ years of relevant experience in Healthcare or a related field.

Required Experience

At least 7+ years in managed healthcare, specifically in health plans or related fields with MMP - Medicare-Medicaid plans. Strong quantitative and analytical skills are required.

For current Molina employees interested in this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. We are an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $77,969 - $141,371 / ANNUAL

Actual compensation may vary based on location, experience, education, and skills.