Medicare EGWP Operations Analyst (Hybrid)

Transformcap; United States; Hybrid; USD 66,000 - 99,000; Full time

Job summary

Judi Health in the United States is seeking a Government Programs Operations Analyst (EGWP) to provide operational and administrative support ensuring timely, compliant Health Plan activities. The role supports EGWP implementation and ongoing oversight of member touchpoints with the Medicare Part D PDP EGWP, aligning CMS guidance with employer and plan objectives.

Responsibilities include setup and go-live readiness, monitoring KPIs and CMS metrics, issue resolution with FDRs, overseeing

Qualifications

• Minimum of HS diploma/GED or equivalent experience.
• 3+ years of Medicare Part D and/or EGWP experience.
• Experience with Medicare Part D enrollment, call center and member communication requirements and reporting.
• Experience working in a delegated and highly matrixed organization.
• Strong operational acumen.
• Strong analytical acumen.

Responsibilities

• Support EGWP program setup, implementation and go-live readiness across assigned internal functions and delegate oversight, which includes enrollment, claims processing, member services, member communications, CAHPS activities and associated member service STARs activities.
• Monitor daily, weekly and monthly performance, operational KPIs and CMS compliance metrics for enrollment, member services, and member communications.
• Support with issue resolution and corrective action completion with related, first tier and downstream entities (FDRs).
• Perform oversight of monthly enrollment audits performed by CMS and semi-annual enrollment reporting.
• Perform oversight of member services and member communications through call evaluations and random sample review or materials and documentation.
• Ensure timely and accurate reporting information is received from both internal and external resources as required by the Health plan.
• Collaborate with account management and/or employer groups on enrollment issues to be resolved by Employer groups to ensure timeliness and compliance with CMS guidance
• Develop compliant documentation for operational areas to include policies, procedures, workflows and other work instructions.
• Support additional functions, as needed.

Skills

Medicare Part D experience

Enrollment and member communications

Analytical acumen

Operational acumen

Education

HS diploma/GED

Tools

HPMS

MARx

CMS systems

Job description

Judi Health in the United States is seeking a Government Programs Operations Analyst (EGWP) to provide operational and administrative support ensuring timely, compliant Health Plan activities. The role supports EGWP implementation and ongoing oversight of member touchpoints with the Medicare Part D PDP EGWP, aligning CMS guidance with employer and plan objectives.

Responsibilities include setup and go-live readiness, monitoring KPIs and CMS metrics, issue resolution with FDRs, overseeing