Medicare Segment Manager

Lifetime Benefit Solutions • Rochester, NY

5d

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 according to approved benefit designs, 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 business plans, evaluates market opportunities, oversees operational assessment and improvement, and leads projects and initiatives supporting Medicare objectives, compliance, efficiency, benefit administration, and customer experience. It collaborates across departments and enterprise teams, maintains stakeholder relationships, and may act as a regulatory liaison. The role also provides Medicare subject matter expertise, interprets government regulations, monitors market and regulatory changes, and helps coordinate planning and execution across departments.

The position requires a bachelor's degree in a relevant field and at least six years of progressive health plan operations experience, along with leadership or management experience, regulatory expertise, project management skills, strong analytical and communication abilities, and the ability to build effective relationships across organizational levels. Travel across health plan service regions may be required. Remote work may be possible 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 dealing with regulatory and accreditation agencies, such as NCQA, CMS, federal and state agencies, including DOH and the 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 skills and follow-through.
• Project management experience.
• Critical-thinking ability and effective negotiation skills with middle and senior management.
• Self-motivated, able to take initiative, and able to work independently at times without detailed direction.
• Strong computer skills, including MS Word, Excel, and PowerPoint.
• Demonstrated analytical ability, strategic thinking, creativity, positive attitude, strong work ethic, and highly effective communication skills.
• Ability to establish effective relationships at all organizational levels, 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 goals for the Medicare lines of business.
• Evaluate new market opportunities and develop 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 effectiveness and efficiency.
• Plan, develop, and implement projects and initiatives supporting line-of-business objectives, products, benefit administration, regulatory requirements, process improvement, efficiency, and customer experience.
• Encourage innovation, process improvement, and personal development in business areas supporting Medicare products.
• Develop and maintain enterprise relationships to promote consistent strategic priorities.
• Serve as a regulatory liaison to NYS, CMS, or BCBSA as needed.
• Collaborate with cross-functional teams to align with line-of-business objectives, compliance, operational performance, and process improvement.
• Ensure integration of Medicare strategies with internal areas including Marketing, Operational Excellence, Population Health Engagement, Finance, Provider Contracting, Compliance, and Enterprise Information Technology.
• Represent Medicare on cross-functional committees and projects to ensure the Medicare perspective is considered.
• Manage maintenance of business process work item deliverables and participate in activities to solicit direct customer feedback.
• Read and interpret complex government regulations and identify necessary next steps.
• Identify issues and solve problems to address potential improvement opportunities.
• Provide Medicare subject matter expertise to business teams on initiatives and activities affecting the line of business.
• Respond to ongoing changes and challenges in the regulatory environment.
• Coordinate with other departments to incorporate perspectives and establish processes and timelines for strategy planning and execution.
• Monitor Medicare market dynamics, connect trends to line-of-business objectives, and inform key business partners.
• Support the company's mission and values, follow the Corporate Code of Conduct, and demonstrate Lifetime Way values and beliefs.
• Protect member privacy in accordance with corporate privacy policies and procedures.
• Maintain regular and reliable attendance and 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager