Medicare Strategy & Operations Lead

Excellus BlueCross BlueShield; City of Utica (NY); Hybrid; USD 79,000 - 142,000; Full time

Job summary

Excellus BlueCross BlueShield in New York seeks a senior professional to support Medicare strategy and execution, ensuring programs align with benefit designs, regulatory requirements, and strategic objectives. You will oversee operations, productivity, and member experience across Medicare Advantage, Part D, Supplements, and Dual Eligible products.

You will develop business plans, evaluate new markets, lead cross-functional initiatives, and serve as a regulatory liaison as needed, collaborating

Qualifications

• Bachelor’s degree in health administration, marketing, business administration or related field.
• Minimum of six years progressive health plan operations experience.
• Strong leadership and/or management experience.
• Regulatory and accreditation knowledge (NCQA, CMS, DOH, etc.).
• Strong process, program management, analytical and problem-solving skills.
• Excellent facilitation, negotiation, and communication skills.
• Self-motivated, able to work independently.
• Strong computer skills: MS Word, Excel, PowerPoint.

Responsibilities

• Develops strategic, operational, and tactical business plans for Medicare lines.
• Evaluates new market opportunities and builds business cases.
• Identifies root causes of noncompliance and customer dissatisfaction.
• Collaborates with teams to streamline operations and improve efficiency.
• Leads projects supporting product, benefit administration, and regulatory needs.
• Serves as Medicare subject matter expert to business teams.
• Liason with NYS, CMS or related agencies as needed.
• Maintains cross-functional alignment across departments and leadership levels.
• Keeps abreast of regulatory changes and translates them into actions.
• Willingness to travel as required.

Skills

Leadership

Regulatory knowledge

Strategic thinking

Analytical ability

Problem solving

Communication skills

Project management

Education

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

Tools

MS Word

Excel

PowerPoint

Job description

Excellus BlueCross BlueShield in New York seeks a senior professional to support Medicare strategy and execution, ensuring programs align with benefit designs, regulatory requirements, and strategic objectives. You will oversee operations, productivity, and member experience across Medicare Advantage, Part D, Supplements, and Dual Eligible products.

You will develop business plans, evaluate new markets, lead cross-functional initiatives, and serve as a regulatory liaison as needed, collaborating