Medicare Strategy & Operations Leader

Excellus BCBS; City of Albany (NY); Ibrido; USD 79.000 - 142.000; Tempo pieno

Descrizione del lavoro

Excellus BCBS is seeking a Medicare Operations professional to support line of business strategy, ensure compliance with benefit design and regulatory requirements, and drive cross-functional initiatives across Marketing, Finance, Compliance, and IT. You will work on Medicare Advantage, Part D, Medigap, and Dual Eligible products.

The role requires strong leadership, regulatory expertise, and the ability to manage complex programs and projects within a dynamic health plan environment.

Competenze

• Bachelor’s degree in health administration, marketing, business administration or related field; 6+ years health plan ops experience.
• Strong leadership and/or management experience.
• Regulatory/ accreditation expertise (NCQA, CMS, DOH, state agencies).
• Strong process and program management skills; analytical and creative problem solving.
• Project management experience required; facilitation skills.

Mansioni

• Develops strategic, operational, and tactical plans for Medicare lines.
• Evaluates new market opportunities and builds business cases.
• Identifies root causes of noncompliance and customer dissatisfaction.
• Coordinates with teams to streamline operations and improve efficiency.
• Leads special projects to support product, benefits, regulatory compliance.
• Serves as SME to business teams on Medicare initiatives.
• Maintains cross-functional relationships and aligns with enterprise strategy.

Conoscenze

Leadership

Regulatory knowledge

Process management

Project management

Negotiation

Analytical thinking

Communication skills

Strategic thinking

Self-motivated

Relationship building

Independent work

Formazione

Bachelor's degree

Strumenti

MS Word

Excel

PowerPoint

Descrizione del lavoro

Excellus BCBS is seeking a Medicare Operations professional to support line of business strategy, ensure compliance with benefit design and regulatory requirements, and drive cross-functional initiatives across Marketing, Finance, Compliance, and IT. You will work on Medicare Advantage, Part D, Medigap, and Dual Eligible products.

The role requires strong leadership, regulatory expertise, and the ability to manage complex programs and projects within a dynamic health plan environment.