Lead Generalist, Medicare Administration (Remote)

Lensa; City of Yonkers (NY); Remote; USD 77,000 - 142,000; Full time

Job summary

A leading career site is seeking a professional to manage Medicare product operations. The role involves developing policies, ensuring compliance, and collaborating with various units to optimize performance. Candidates should have extensive experience in healthcare and Medicare operations.

Benefits

Competitive Benefits and Compensation Package

Qualifications

• 7+ years in healthcare or related field.
• At least 7 years in managed healthcare, specifically with MMP.

Responsibilities

• Manage benefits, operations, and communication for Medicare product.
• Ensure operational compliance with federal regulations.
• Develop infrastructure and policies for Medicare programs.

Skills

Health Plan Operations

Medicare

Analytical Skills

Operational Process Improvements

Education

BA/BS Degree

Job description

Job Description

Lensa is the leading career site for job seekers at every stage of their career. Our client, Molina Healthcare, is seeking professionals. Apply via Lensa today!

Job Summary

Responsible for managing benefits, operations, communication, reporting, and data exchange of the Medicare product to support strategic and corporate objectives. Develops infrastructure, standards, policies, and procedures for the Medicare and Dual Eligible Program, and participates in the strategic development of its products and services. Ensures operational compliance with 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; data exchanges and reports are accurate, timely, and meet federal requirements.

Knowledge/Skills/Abilities

• Demonstrates expertise in health plan operations, 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, reporting, and new member acquisition
• Supports department leaders on sales, compliance, analytics, strategy, and policy tasks
• Develops Medicare Advantage analytic reports

Job Qualifications

Required Education

BA/BS degree or equivalent employment experience of 7+ years in healthcare or a related field

Required Experience

At least 7 years in managed healthcare, specifically with MMP - Medicare-Medicaid plans. Strong quantitative and analytical skills are essential.

To current Molina employees: Please apply through the intranet job listing if interested.

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