Medicare Strategy & Operations Lead

Excellus BCBS; City of Rochester (NY); Remote; USD 79,000 - 142,000; Full time

Job summary

Excellus BCBS in Rochester, NY seeks a Medicare Operations leader to support strategy and execution across Medicare products including MA, Part D, and dual eligible plans. The role ensures programs are administered per approved benefit design and regulatory requirements.

The candidate will drive strategic plans, evaluate market opportunities, and coordinate with Marketing, Compliance, and IT to integrate Medicare initiatives across departments.

Qualifications

• Bachelor’s degree in health administration, marketing, business administration or related field.
• Six years progressive health plan operations experience.
• Strong leadership and/or management experience.
• Experience with regulatory and accreditation agencies (NCQA, CMS, DOH, etc.).

Responsibilities

• Develops strategic, operational, and tactical business plans for Medicare lines of business.
• Collaborates with cross functional teams to ensure alignment to objectives and regulatory requirements.
• Conducts evaluations of operations to identify root causes of noncompliance and customer dissatisfaction.
• Serves as a regulatory liaison to NYS, CMS, or BCBSA as needed.

Skills

Leadership

Management

Project management

Negotiation

Communication

Analytical ability

Strategic thinking

Problem solving

Education

Bachelor’s degree in health administration, marketing, business administration or related field

Tools

MS Word

Excel

PowerPoint

Job description

Excellus BCBS in Rochester, NY seeks a Medicare Operations leader to support strategy and execution across Medicare products including MA, Part D, and dual eligible plans. The role ensures programs are administered per approved benefit design and regulatory requirements.

The candidate will drive strategic plans, evaluate market opportunities, and coordinate with Marketing, Compliance, and IT to integrate Medicare initiatives across departments.