Lead Generalist, Medicare Administration (Remote)

Lensa; United States; Remote; USD 77,000 - 142,000; Full time

Job summary

An established industry player is seeking a skilled professional to manage the Medicare product's operations, benefits, and compliance. This role involves developing infrastructure and standards to support strategic objectives while ensuring accurate data exchanges and member communications. The ideal candidate will have extensive experience in managed healthcare, particularly with Medicare-Medicaid plans, and strong analytical skills. Join a dynamic team that values operational excellence and compliance in a rewarding environment, offering competitive compensation and benefits.

Qualifications

• Expertise in health plan operations and Medicare-Medicaid plans.
• Strong analytical skills with 7+ years in managed healthcare.

Responsibilities

• Manage benefits and operations of the Medicare product.
• Ensure compliance with federal regulations and operational standards.

Skills

Health plan operations expertise

Medicare and MMP program knowledge

Operational process improvements

Analytical skills

Education

BA/BS degree

7+ years of relevant healthcare experience

Job description

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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 to support strategic and corporate business objectives. Develops infrastructure, standards, policies, and procedures for the Medicare and Dual Eligible Program. Participates in 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 accurately 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, serving as a department leader
• Supports functional business owners in operational process improvements
• Supports Medicare-Medicaid plans on member retention, performance, reporting, and acquisition goals
• Assists department leaders on projects involving sales, compliance, analytics, strategy, and policy
• Develops Medicare Advantage analytic reports

Job Qualifications

Required Education

BA/BS degree or minimum 7+ years of relevant healthcare experience

Required Experience

7+ years in managed healthcare, specifically with MMP - Medicare-Medicaid plans. Strong analytical skills required.

Current Molina employees interested in this position should apply through the intranet.

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

Additional Information

• Compensation varies based on location, experience, education, and skills.
• Seniority level: Mid-Senior level
• Employment type: Full-time
• Job function: Human Resources
• Industries: IT Services and IT Consulting