Lead Generalist, Medicare Administration (Remote)

Molina Healthcare; Kent (OH); Remote; USD 77,000 - 142,000; Full time

Job summary

An established industry player is seeking a skilled professional to oversee the management of Medicare operations, ensuring compliance with federal regulations and enhancing operational efficiencies. This role involves developing standards and policies while collaborating with various departments to optimize member retention and performance. With a focus on strategic development and accurate reporting, the position offers a chance to make a significant impact on healthcare delivery. Join a forward-thinking organization that values innovation and excellence in service delivery, and be part of a team that is dedicated to improving the health outcomes of its members.

Qualifications

• 7+ years in managed healthcare industry required.
• Strong quantitative and analytical skills needed.

Responsibilities

• Manage benefits, operations, and compliance for Medicare product.
• Develop infrastructure and policies for Medicare and Dual Eligible Program.

Skills

Health Plan Operations

Medicare Program Requirements

Operational Process Improvements

Quantitative Analytical Skills

Compliance

Education

BA/BS degree

7+ years in Health Care or related field

Job description

JOB DESCRIPTION

Job Summary

Responsible for the management of the benefits, operations, communication, reporting, and data exchange of the Medicare product in support of strategic and corporate business objectives. Develops infrastructure, standards, and policies and procedures for the Medicare and Dual Eligible Program and participates in the strategic development of its products and services. Also responsible for operational compliance and adherence to federal regulations. Works collaboratively with business and operational units to ensure the Medicare and Dual Eligible operations are supported by effective, accurate and efficient business processes; benefits are accurately defined, communicated, and configured; all member communications are compliant and data exchanges and reports are accurate, timely and meet federal requirements.

KNOWLEDGE/SKILLS/ABILITIES

• The lead demonstrates superior SME on health plan operations and Medicare and MMP program requirements, and is looked to within the department as a leader.
• Assist functional business owners identify and implement operational process improvements.
• Support Medicare-Medicaid plans on Medicare and MMP member retention, performance optimization, MMP reporting, and new member acquisition objectives.
• Support department leaders on wide-ranging assignments involving sales, compliance, analytics, strategy, and policy.
• Develop Medicare Advantage analytic reports.

JOB QUALIFICATIONS

Required Education

BA/BS degree or minimum equivalent employment experience of 7+ years in Health Care or related field required.

Required Experience

7+ years of experience in the managed healthcare industry in a health plan or related field with MMP - Medicare-Medicaid plans. Must have strong, quantitative, analytical skills and ability.

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

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

Pay Range: $77,969 - $141,371 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.