About the role
Job Description
Provide advanced department, divisional and/or segment-focused business and operational leadership support for Medicare Advantage and Medicare Supplement lines of business, including business relationship management, business plan development, reporting, data and budget analysis, and execution of high-priority initiatives. Serve as a business partner in advancing growth, profitability, and member experience through key Medicare value levers including Risk Adjustment, Star Ratings, CAHPS, provider performance, network effectiveness, and operational execution.What You'll Do
Business and Strategic Planning
Build and facilitate repeatable business management processes that support Medicare Advantage and Medicare Supplement growth, profitability, compliance, and operational performance, including progress evaluation and communication to affected stakeholders.
Lead the coordination, planning and facilitation of various departmental/divisional events (i.e. Departmental Summits, All Hands Meetings, Leadership Planning Sessions, staff meetings) to make them more effective, purposeful and outcomes based.
Partner with leadership to monitor business performance and key Medicare value drivers including Risk Adjustment, Star Ratings, CAHPS performance, provider enablement, operational efficiency, retention, and membership growth.
May produce segment business plans and analysis under guidance from Segment Lead.
Facilitate the adoption of standard operating procedures and processes for the department and assist with the communication and education of new SOPs outside of the department.
Facilitate change management work to support business and process improvements and overall departmental/divisional effectiveness.
Project Management
Lead special projects for the department/division/segment as assigned. Possible duties could include:
Evaluation of potential opportunities and recommendations to reduce costs/improve efficiencies
Review and evaluation of best or next practice opportunities for potential adoption
Develop recommendations based on industry trends, CMS guidance, competitive intelligence, and market dynamics impacting Medicare Advantage and Medicare Supplement performance, growth, quality outcomes, and operational effectiveness.
Serve as lead on engagements with external entities (i.e. consultants) and coordinate data gathering and research efforts based on the direction of leadership.
Manage tracking of initiatives/projects for the department/division/segment and independently create presentations of initiative/project progress for varied audiences, which may include ILT and Senior Leadership.
Data Analysis/Reporting
Identify trends, risks, and opportunities impacting Medicare Advantage and Medicare Supplement performance and develop actionable recommendations for leadership.
Coordinate departmental/divisional budget analysis, provide input into and monitor budget forecasts and review progress against administrative cost reduction goals
Track and evaluate goal progress, including data collection and analysis of key performance metrics (KPIs)
Business Partnerships
Improve and strengthen business partnerships and stakeholder relationships for the department/division through focus on proactive communications, relationship building, and process improvements
Facilitate the completion of the Annual Report, CEO/Board reports, and other marketing/communication opportunities with a focus on partnering to deliver communications that are relevant and oriented to specific business partnerships both internal and external.
Provide input and recommended strategy for leadership’s public speaking engagements and/or industry Board or committee meetings.
Coordinate and manage vendor relationships as required by business operations’ needs.
What You Have
Bachelor's degree or advanced degree (where required)
5+ years of experience in related field.
In lieu of degree, 7+ years of experience in related field.
Bonus Points
Demonstrated experience supporting Medicare Advantage and/or Medicare Supplement business operations, product performance, growth initiatives, or market management.
Strong knowledge of Medicare value levers including Risk Adjustment, Star Ratings, CAHPS, provider performance, quality programs, and operational excellence.
Experience translating complex business, operational, and market data into executive-level insights and recommendations.
Proven ability to lead cross-functional initiatives involving Product, Operations, Clinical, Network, Finance, Actuarial, Marketing, and Data & Analytics teams.
Knowledge of CMS regulations, Medicare product performance management, competitive market dynamics, and healthcare industry trends.
What You’ll Get
The opportunity to work at the cutting edge of health care delivery with a team that’s deeply invested in the community
Work-life balance, flexibility, and the autonomy to do great work
Medical, dental, and vision coverage along with numerous health and wellness programs
Parental leave and support plus adoption and surrogacy assistance
Career development programs and tuition reimbursement for continued education
401k match including an annual company contribution
Learn more
Salary Range
At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs. Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs.
*Based on annual corporate goal achievement and individual performance.
$89,174.00 - $142,679.00Skills
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Originally posted on Himalayas