Lead Generalist, Medicare Administration (Remote)

Lensa; Saint Petersburg (FL); Remote; USD 77,000 - 142,000; Full time

Job summary

An established industry player is seeking a dedicated professional to lead the management of Medicare products, ensuring compliance with federal regulations and operational excellence. This role involves developing strategic infrastructure and policies, collaborating with various departments to enhance operational processes, and supporting member retention and acquisition objectives. With a focus on analytics and performance optimization, this position offers a unique opportunity to impact the healthcare landscape positively. Join a forward-thinking company that values innovation and compliance in the healthcare sector.

Qualifications

• 7+ years in managed healthcare with Medicare-Medicaid plans.
• Strong analytical skills required for operational compliance.

Responsibilities

• Manage benefits, operations, and communication for Medicare products.
• Develop infrastructure and policies for Medicare and Dual Eligible Programs.

Skills

Health Plan Operations

Medicare Program Requirements

Operational Process Improvements

Quantitative Analytical Skills

Education

BA/BS Degree

7+ Years Experience in Health Care

Job description

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.