Description
This role manages Medicare Advantage related programmes, partnering with leadership to ensure operational performance, regulatory compliance, and quality outcomes.
Key Responsibilities:
- Lead daily market operations of the Medicare Advantage programme, ensuring CMS regulation compliance
- Develop and implement operational strategies to support enrolment, product development, and member services
- Ensure operational readiness for CMS audits and regulatory changes
- Partner with Compliance and Legal teams to interpret CMS guidance and regulations
- Drive performance improvements related to Star Ratings, member experience, and operational KPIs
- Collaborate with Finance on budgeting, forecasting, and cost management
- Foster local market accountability and continuous improvement
- Support growth initiatives, including new market entry and benefit design changes
- Leverage data and reporting to identify trends and opportunities for operational enhancement
Requirements:
- Bachelor's degree
- 5+ years of Medicare Advantage experience
- Relevant experience with CMS audits, STAR ratings optimisation, and quality improvement initiatives
- Background in payer operations, health plans, or value-based care organisations
- Knowledge of delegated and vendor management models
- Lean, Six Sigma, or other process improvement certification
Preferred Qualifications:
- Programme management experience
Benefits:
- Generous benefits package covering wellness, health, happiness, security, and engagement
Salary: $59.50 - $91.84 per hour