Lead Generalist, Medicare Administration (Remote)

Lensa; Louisville (KY); Remote; USD 77,000 - 142,000; Full time

Job summary

An established industry player is seeking a dedicated professional to oversee the Medicare product's benefits and operations. This role involves developing infrastructure and ensuring compliance with federal regulations while collaborating with various operational units. The ideal candidate will have extensive experience in managed healthcare, particularly with Medicare-Medicaid plans, and possess strong analytical skills. This position offers a competitive compensation package and an opportunity to make a significant impact in the healthcare sector.

Qualifications

• 7+ years in managed healthcare industry with MMP - Medicare-Medicaid plans.
• Strong quantitative and analytical skills required.

Responsibilities

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

Skills

Health Plan Operations

Medicare and MMP Program Requirements

Operational Process Improvements

Quantitative and Analytical Skills

Education

BA/BS degree

7+ years in Healthcare or related field

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 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 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 recognized as a leader within the department.
• Assist functional business owners in identifying and implementing operational process improvements.
• Support Medicare-Medicaid plans on member retention, performance optimization, MMP reporting, and new member acquisition objectives.
• Support department leaders on 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 Healthcare or a related field.

Required Experience

7+ years in the managed healthcare industry with MMP - Medicare-Medicaid plans. Strong quantitative and analytical skills required.

To all current Molina employees: If interested in 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 based on geographic location, work experience, education, and skill level.