Medicare Strategy & Operations Lead

Excellus BCBS; United States; Remote; USD 79,000 - 142,000; Full time

Benefits offered by this job

Remote work potential

Job summary

Excellus BCBS is seeking a strategic leader to support Medicare line of business strategy and execution. You will oversee that Medicare Advantage, Supplement, Part D and Dual Eligible products align with approved design, regulatory requirements and corporate objectives.

You will collaborate with Marketing, Compliance, Finance and IT, driving cross-functional initiatives, process improvements, and enhanced member experience across regions.

Qualifications

• Bachelor’s degree with a minimum of six years progressive health plan operations experience.
• Strong leadership and/or management experience.
• Strong expertise and background dealing with regulatory and accreditation agencies such as NCQA, CMS, Federal & State agencies including DOH, Dept. of Finance Services.
• Regulatory requirements awareness and ability to remain current.
• Strong process and program management, analytical and problem-solving skills.
• Project management experience is required.
• Excellent negotiation and communication abilities across senior management levels.
• Self-motivation and ability to work independently with limited direction.
• Proficient with MS Word, Excel and PowerPoint.

Responsibilities

• Develops strategic, operational, and tactical business plans for Medicare lines of business.
• Evaluate new market opportunities and build business cases.
• Identify root causes of operations problems affecting compliance and customer satisfaction.
• Streamline system operations and processes across teams for better efficiency.
• Lead special projects supporting product administration, regulatory requirements, and customer experience.
• Foster innovation and cross-functional collaboration to align strategies.

Skills

Leadership

Regulatory knowledge

Analytical thinking

Communication skills

Project management

Negotiation skills

Independent work

MS Office

Education

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

Tools

MS Word

Excel

PowerPoint

Job description

Excellus BCBS is seeking a strategic leader to support Medicare line of business strategy and execution. You will oversee that Medicare Advantage, Supplement, Part D and Dual Eligible products align with approved design, regulatory requirements and corporate objectives.

You will collaborate with Marketing, Compliance, Finance and IT, driving cross-functional initiatives, process improvements, and enhanced member experience across regions.