Lead Generalist, Medicare Administration

Job Summary

Responsible for the management of the benefits, operations, communication, reporting, and data exchange of the Medicare product in support of strategic and corporate business objectives. Develops infrastructure, standards, and policies and procedures for the Medicare and Dual Eligible Program and participates in the strategic development of its products and services. Also responsible for operational compliance and adherence to federal regulations. Works collaboratively with business and operational units to ensure the Medicare and Dual Eligible operations are supported by effective, accurate and efficient business processes; benefits are accurately defined, communicated, and configured; all member communications are compliant and data exchanges and reports are accurate, timely and meet federal requirements.

Knowledge / Skills / Abilities

The lead demonstrates superior SME on health plan operations and Medicare and MMP program requirements, and is looked to within the department as a leader. Assist functional business owners identify and implement operational process improvements. Support Medicare-Medicaid plans on Medicare and MMP member retention, performance optimization, MMP reporting, and new member acquisition objectives. Support department leaders on wide-ranging assignments involving sales, compliance, analytics, strategy, and policy. Develop Medicare Advantage analytic reports.

Job Qualifications

Required Education : BA / BS degree or minimum equivalent employment experience of 7+ years in Health Care or related field required. Required Experience : 7+ years of experience in the managed healthcare industry in a health plan or related field with MMP - Medicare-Medicaid plans. Must have strong, quantitative, analytical skills and ability.