Medicare Strategy & Operations Lead (Remote)

Excellus BCBS; Oregon; Hybrid; USD 79,000 - 142,000; Full time

Job summary

Excellus BCBS in the United States seeks a Senior Manager to oversee Medicare line of business strategy and execution, ensuring products and programs comply with approved benefit design, regulatory requirements, and strategic objectives.

The role requires leading cross-functional teams, developing plans, evaluating opportunities, and ensuring operational performance while maintaining member privacy and adapting to changes in regulation.

Qualifications

• Bachelor’s degree in health administration, marketing, business administration or related field.
• Minimum six years of progressive health plan operations experience.
• Strong leadership and management experience.
• Experience with regulatory and accreditation agencies such as NCQA, CMS, DOH.
• Excellent analytical, problem solving and communication skills.
• Project management experience required.
• Self-motivated with ability to work independently.
• Proficiency in MS Word, Excel and PowerPoint.

Responsibilities

• Develops strategic, operational, and tactical business plans for Medicare lines of business.
• Evaluates new market opportunities and builds business cases.
• Assesses operations to identify root causes of problems affecting compliance and customer satisfaction.
• Collaborates with teams to streamline operations and improve efficiency.
• Plans and implements projects to support line of business objectives and regulatory requirements.
• Drives process improvements and cross-functional initiatives.
• Maintains relationships across the enterprise to align strategic priorities.
• Serves as regulatory liaison to NYS, CMS or BCBSA as needed.
• Represents Medicare in cross-functional committees to integrate perspectives.
• Keeps abreast of evolving Medicare market dynamics and regulatory changes.

Skills

Leadership

Regulatory compliance

Project management

Process improvement

Strategic thinking

Communication skills

Negotiation

Self-motivation

MS Office proficiency

Education

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

Job description

Excellus BCBS in the United States seeks a Senior Manager to oversee Medicare line of business strategy and execution, ensuring products and programs comply with approved benefit design, regulatory requirements, and strategic objectives.

The role requires leading cross-functional teams, developing plans, evaluating opportunities, and ensuring operational performance while maintaining member privacy and adapting to changes in regulation.