Medicare Segment Manager
About The Position
Under the general direction of assigned management, the Medicare Segment Manager supports Medicare line-of-business strategy and execution. The role ensures Medicare products and programs are administered in accordance with approved benefit design, regulatory requirements, and strategic objectives, and is accountable for related service and operational requirements. The incumbent is expected to be knowledgeable about Medicare Advantage, Medicare Supplement, Part D Prescription Drug Plans, and Dual Eligible products. The position develops and executes business plans and initiatives, evaluates market opportunities and operational performance, and works across departments to improve compliance, efficiency, and customer experience. It also provides Medicare subject matter expertise, supports regulatory engagement, and maintains awareness of changes in regulations and Medicare market dynamics. Travel across health plan service regions may be required. The stated compensation range is $79,068–$142,322. Actual compensation may vary based on factors including budget, experience, knowledge, skills, education, and internal equity. The total rewards package may include group health and/or dental insurance, a retirement plan, a wellness program, paid time away from work, and paid holidays. Remote work may be available on a case-by-case basis.
Requirements
- Bachelor’s degree in health administration, marketing, business administration, or a related field.
- At least six years of progressive health plan operations experience.
- Strong leadership and/or management experience.
- Strong expertise and background working with regulatory and accreditation agencies such as NCQA, CMS, federal and state agencies, including DOH and Department of Financial Services.
- Remain current on relevant regulatory requirements.
- Strong process and program management skills, analytical ability, creativity, and initiative in problem solving and identifying solutions.
- Strong facilitation and follow-through skills; project management experience is required.
- Critical thinking and effective negotiation skills when dealing with middle and senior management.
- Self-motivated and able to work independently without detailed direction at times.
- Strong computer skills, including Microsoft Word, Excel, and PowerPoint.
- Demonstrated analytical ability, strategic thinking, creativity, a positive attitude, a strong work ethic, and highly effective communication skills.
- Ability to establish effective relationships with representatives at all levels across divisions, including senior management, to execute cross-divisional initiatives.
- Ability to travel across health plan service regions as needed.
Responsibilities
- Develop strategic, operational, and tactical business plans to achieve business goals for Medicare lines of business.
- Evaluate new market opportunities, including developing necessary business cases.
- Assess operations to identify root causes of problems contributing to noncompliance and customer dissatisfaction.
- Consult with team members and stakeholders to streamline systems and processes and improve business effectiveness and efficiency.
- Plan, develop, and implement projects and initiatives supporting line-of-business objectives, product and benefit administration, regulatory requirements, process improvement, efficiency, and customer experience.
- Encourage innovation, process improvements, and professional development within business areas supporting Medicare products.
- Build and maintain relationships across the enterprise to promote consistent strategic priorities.
- Serve as a regulatory liaison to NYS, CMS, or BCBSA as needed.
- Collaborate with cross-functional teams to align line-of-business objectives, compliance, operational performance, and process improvement.
- Integrate Medicare strategies with internal areas including Marketing, Operational Excellence, Population Health Engagement, Finance, Provider Contracting, Compliance, and Enterprise Information Technology; represent Medicare on relevant committees and projects.
- Manage maintenance of business process work-item deliverables and participate in activities that gather direct customer feedback.
- Read and interpret complex government regulations and identify necessary next steps.
- Identify issues and solve problems to resolve potential improvement opportunities.
- Provide Medicare line-of-business subject matter expertise to business teams on initiatives and activities that affect Medicare.
- Respond to ongoing changes and challenges in the regulatory environment.
- Coordinate with other departments to incorporate their input and perspectives and develop processes and timelines for planning and executing strategies.
- Monitor Medicare market dynamics, connect trends to line-of-business objectives, and keep key business partners informed.
- Support the company's mission and values, comply with the Corporate Code of Conduct, and uphold Lifetime Way values and beliefs.
- Protect member privacy in accordance with corporate privacy policies and procedures.
- Maintain regular and reliable attendance.
- Perform other functions as assigned by management.
Benefits
- Group health insurance may be included in the total rewards package.
- Dental insurance may be included in the total rewards package.
- Retirement plan may be included in the total rewards package.
- Wellness program may be included in the total rewards package.
- Paid time away from work may be included in the total rewards package.
- Paid holidays may be included in the total rewards package.
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What This Job Offers
Job Type
Full-time
Career Level
Manager
