Remote Medicare Operations Program Lead (MA/EGWP)

bcbsa; United States; On-site; USD 105,000 - 153,000; Full time

Job summary

Blue Cross Blue Shield Association (BCBSA) is seeking an Operations Manager for the Federal Employee Program (FEP) Medicare Advantage EGWP line. You will oversee day-to-day MA/EGWP operations, ensuring regulatory compliance with CMS, OPM, and internal policies while driving efficiency and audit readiness.

This role partners with FEPOC MA Operations, Compliance, Product, Clinical, Network, and IPP to ensure compliant product builds, implement cross‑functional initiatives, and improve member and

Qualifications

• 8+ years in Medicare/Medicare Advantage operations and health insurance.
• BS in Healthcare, Business Administration, Public Health, or related field; or equivalent experience.
• Strong regulatory and CMS knowledge.
• Ability to lead cross-functional programs with diverse stakeholders.
• Experience with core processing platforms (Facets, HealthEdge, QNXT).
• Excellent written, oral communication and executive-level presentation skills.

Responsibilities

• Oversee day-to-day MA EGWP operations ensuring compliance and audit readiness.
• Lead cross-functional initiatives to improve member/provider experiences.
• Partner with FEPOC MA Ops, Compliance, Product, Clinical, Network, and IPP for compliant builds.
• Manage vendor relationships, contracts, and RFPs; participate in governance.
• Monitor KPIs/SLAs and regulatory reporting; drive continuous improvement.

Skills

Medicare/MA knowledge

CMS regulations

Cross-functional leadership

Data analysis

Executive communication

MS Office

PM tools & data viz

Stakeholder management

TPAs/BPOs experience

Core processing platforms

Education

Bachelor's degree in Healthcare, Business Administration, Public Health, or related field

Job description

Blue Cross Blue Shield Association (BCBSA) is seeking an Operations Manager for the Federal Employee Program (FEP) Medicare Advantage EGWP line. You will oversee day-to-day MA/EGWP operations, ensuring regulatory compliance with CMS, OPM, and internal policies while driving efficiency and audit readiness.

This role partners with FEPOC MA Operations, Compliance, Product, Clinical, Network, and IPP to ensure compliant product builds, implement cross‑functional initiatives, and improve member and