Medicare Segment Manager

Excellus BCBS•Rochester, NY

About The Position

Under the general direction of assigned management, the Medicare Segment Manager supports strategy and execution for the Medicare line of business, ensuring that products and programs are administered according to approved benefit designs, regulatory requirements, and strategic objectives. The role is accountable for Medicare service and operational requirements and requires knowledge of Medicare Advantage, Medicare Supplement, Part D Prescription Drug Plans, and Dual Eligible products. The position develops and implements business plans and initiatives, evaluates market opportunities and operational performance, and works with stakeholders to improve processes, compliance, efficiency, and the customer experience. It collaborates across departments and serves as a source of Medicare subject-matter expertise, while staying current on market trends and changing regulations. The role may serve as a regulatory liaison and represents Medicare on relevant cross-functional committees and projects. The position requires travel across health plan service regions as needed. The posting notes that remote work may be available on a case-by-case basis. The compensation range is $79,068–$142,322; actual salary depends on factors including budget, experience, knowledge, skills, education, and internal equity. Potential components of the total rewards package include group health and/or dental insurance, a retirement plan, a wellness program, paid time away from work, and paid holidays.

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, including NCQA, CMS, federal and state agencies, the Department of Health, and the Department of Financial Services.
Maintain current knowledge of relevant regulatory requirements.
Strong process and program management skills.
Analytical ability, creativity, and initiative in problem solving and solution identification.
Strong facilitation skills and follow-through.
Project management experience.
Critical-thinking ability and effective negotiation skills when dealing with middle and senior management.
Self-motivated and able to work independently at times without detailed direction.
Strong computer skills, including Microsoft Word, Excel, and PowerPoint.
Demonstrated analytical ability, strategic thinking, and creativity, as well as a positive attitude, 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 goals for Medicare lines of business.
Evaluate market opportunities, including developing necessary business cases.
Assess operations to identify root causes of problems contributing to noncompliance and customer dissatisfaction.
Consult with 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 improvement, and personal 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 business and project teams to support alignment with 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 cross-functional committees and projects to ensure its perspective is incorporated into other areas’ strategies.
Manage maintenance of business process work-item deliverables and participate in forums and 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 that affect the line of business.
Respond to ongoing changes and challenges in the regulatory environment.
Coordinate with other departments, consider their perspectives, and develop processes and timelines for planning and executing strategies across departments.
Monitor Medicare market dynamics, connect trends to line-of-business objectives, and keep key business partners informed.
Support the Lifetime Healthcare Companies’ mission and values, adhere to the Corporate Code of Conduct, and lead according to 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.