Lead Generalist, Medicare Administration (Remote)

Lensa; Sterling Heights (MI); Remote; USD 77,000 - 142,000; Full time

Job summary

A leading healthcare company is seeking a professional to manage Medicare product operations, ensuring compliance and operational efficiency. The role involves developing policies, collaborating with teams, and optimizing performance in Medicare-Medicaid plans. Ideal candidates will have extensive experience in healthcare operations and strong analytical skills.

Benefits

Competitive Benefits

Compensation Package

Qualifications

• 7+ years of relevant employment experience in Healthcare or related field.
• 7+ years in the managed healthcare industry, specifically with health plans.

Responsibilities

• Manage benefits, operations, communication, reporting, and data exchange of the Medicare product.
• Ensure operational compliance with federal regulations.

Skills

Health Plan Operations

Operational Process Improvements

Quantitative Skills

Analytical Skills

Education

BA/BS Degree

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, supporting 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 with federal regulations. Collaborates with business and operational units to support Medicare and Dual Eligible operations through effective, accurate, and efficient processes. Ensures 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 knowledge of health plan operations and Medicare and MMP program requirements, recognized as a leader within the department.
• 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 various assignments involving sales, compliance, analytics, strategy, and policy.
• Develops Medicare Advantage analytic reports.

Job Qualifications

Required Education

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

Required Experience

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

Current Molina employees interested in this position should 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 annually. Actual compensation may vary based on location, experience, education, and skills.