Remote Medicare Ops Program Lead MA EGWP

Blue Cross and Blue Shield of Kansas Inc.; Chicago, Northern (IL, KY); Hybrid; USD 120,000 - 160,000; Full time

Benefits offered by this job

Annual bonus

Medical/dental/vision insurance

401(k) matching

Paid time off and holidays

Job summary

Blue Cross Blue Shield Association is hiring for a senior role overseeing the Federal Employee Program MA EGWP operations. The candidate will drive day-to-day workflows, ensure CMS and CMS-related regulations compliance, and partner with FEPOC MA Operations and cross-functional teams to deliver compliant, timely products.

Strong analytics, stakeholder management, and experience with major core systems are required.

Qualifications

• BS or equivalent experience in healthcare/administration.
• 8+ years in Medicare/MAPD operations or healthcare operations.
• Deep knowledge of Medicare Advantage, Part D, and CMS regulations.
• Experience leading large cross-functional programs with TPAs/BPOs.
• Experience with core processing platforms like Facets, HealthEdge, QNXT.

Responsibilities

• Oversee day-to-day operational work streams for FEP MA EGWP line.
• Ensure regulatory compliance with FEP, CMS, and OPM requirements.
• Drive continuous improvement and cross-functional initiatives.
• Partner with FEPOC MA Operations, Compliance, Product, and IPP teams.
• Manage vendor relationships, contracts, and RFPs; report KPIs and SLAs.

Skills

Medicare Advantage

Regulatory understanding

Project management

Analytics

Stakeholder management

Communication

Microsoft Office

Data visualization

Education

BS in Healthcare, Business Administration, Public Health, or related field

Tools

Facets

HealthEdge

QNXT

Job description

Blue Cross Blue Shield Association is hiring for a senior role overseeing the Federal Employee Program MA EGWP operations. The candidate will drive day-to-day workflows, ensure CMS and CMS-related regulations compliance, and partner with FEPOC MA Operations and cross-functional teams to deliver compliant, timely products.

Strong analytics, stakeholder management, and experience with major core systems are required.