Lead, Medicare Administration (Remote)

Job Summary

Provides lead level support for Medicare and Medicare-Medicaid Plan (MMP) Duals products including the development, implementation, and maintenance of annual project timelines/work plans for both product lines - ensuring timely and successful project completion. Supports the annual Medicare and MMP plan applications and Plan Benefit Package (PBP) design, provides centralized core beneficiary communications support, and assists both lines of business for upcoming contract year business readiness.

Essential Job Duties

• Demonstrates deep knowledge of Medicare and MMP program requirements, including Centers for Medicare Services (CMS) regulations, operational workflows, and compliance standards.
• PARTNERS WITH FUNCTIONAL BUSINESS OWNERS TO IDENTIFY, RECOMMEND, AND IMPLEMENT PROCESS IMPROVEMENTS THAT ENHANCE EFFICIENCY AND MEMBER EXPERIENCE.
• SUPPORTS MEDICARE AND MMP PLANS IN ACHIEVING OBJECTIVES RELATED TO MEMBER RETENTION, ACQUISITION, AND OVERALL PERFORMANCE THROUGH DATA-DRIVEN STRATEGIES AND INITIATIVES.
• COLLABORATES WITH DEPARTMENT LEADERS ON DIVERSE ASSIGNMENTS INVOLVING SALES, COMPLIANCE, ANALYTICS, POLICY DEVELOPMENT, AND STRATEGIC PLANNING.
• DEVELOPS AND MAINTAINS MEDICARE-SPECIFIC ANALYTICS REPORTS TO MONITOR KEY PERFORMANCE INDICATORS, IDENTIFY TRENDS, AND SUPPORT DECISION-MAKING.

Required Qualifications

• At least 4 years’ experience in in Medicare/health care process design and development, business analysis, and/or compliance, and 1 year of project management experience, or equivalent combination of relevant education and experience.
• PROJECT MANAGEMENT SKILLS.
• STRONG QUANTITATIVE ANALYTICAL SKILLS AND ABILITIES.
• STRONG MULTI-TASKING SKILLS AND ABILITY TO NAVIGATE VARIOUS SOFTWARE SYSTEMS.
• ABILITY TO COLLABORATE CROSS-FUNCTIONALLY.
• STRONG VERBAL AND WRITTEN COMMUNICATION SKILLS.
• MICROSOFT OFFICE SUITE AND APPLICABLE SOFTWARE PROGRAM(S) PROFICIENCY.

Preferred Qualifications

• Medicare or Medicare-Medicaid Plan (MMP) experience.