Mgr Medicare Advantage Operations
- Blue Cross and Blue Shield of Nebraska (BCBSNE)
- NE
- Full Time
- 12 days ago
Salary
N/A
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Job Description
Blue Cross and Blue Shield of Nebraska (BCBSNE) is more than just an insurance company; we exist to be there for people in the best and hardest moments of their lives.
Our team is the power behind that promise. And, as the industry rapidly evolves and we seek ways to optimize business processes and customer experiences, there’s no greater time for forward-thinking professionals like you to join us in delivering on it!
As a member of Team Blue, you’ll find purpose, opportunities and the support you need to build a meaningful career and make a powerful impact in our community.
Supports the Medicare Advantage Business unit to engage & lead cross functional operational resources internally as well as external partner resources for the successful implementation and ongoing support of the Medicare Advantage portfolio. Support key drivers of success in the MA market around member satisfaction, STAR ratings, and successful implementation of quality, medical management and provider contracting activities that support program goals. BCBSNE is happy to offer four work designations for our Omaha area employees: 100% in-office, Hybrid options, and 100% remote. If choosing to work remote, this role can be located in one of the following states: Colorado, Florida, Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, and Texas.
What you'll do:
1. Directs internal cross functional workgroups and projects that support all functions of delivering successful results to the Medicare Advantage/product line (annual bid application, product development/updates, member communications, internal/external training, development & maintenance of operational policies, etc).
2. Responsible for the implementation and maintenance of all Medicare Advantage activities and programs across the Market in support of the Medicare Advantage core operations.
3. Direct overall operations support and project management activities and provides guidance to functional departments within BCBSNE that support the Medicare Advantage portfolio. These departments include but are not limited to Sales, Marketing, Product Development, Compliance, Audit, Fraud, Risk Adjustment, Actuarial, Claims, Customer Service, Pharmacy and Provider, including Network.
4. Coordinates and supports strategies regarding legislative issues and regulatory changes with a key function in program and project management in support of Medicare Advantage and Medicare Part D, including Stars, Revenue Management, Quality and Network concerns.
5. Participates on various committees to represent the Medicare Advantage Department both internally from an operations standpoint as well as externally from a strategic and vendor partnership standpoint. Manages day to day external relationships with external vendor partnerships. Provides oversight and coordination of audit functions of external vendor relationships.
To be considered for this position, you must have:
- Bachelors Degree in Project Management or Operations and five (5) years of experiences in operations leading cross-functional workgroups for a Health Insurance company. An equivalent combination of education and experience may be substituted to meet this requirement.
- The ability to meet or exceed the attendance and timeliness requirements of their departments.
- The ability to work well in a team environment and be capable of building and maintaining positive relationships with other staff, departments, and customers.
The strongest candidates for this position will also possess:
- Five (5) years' experience in Medicare Advantage Operations and/or Medicare compliance functions or project management
Learn more about what makes BCBSNE such an exceptional place to work by visiting
NebraskaBlue.com/Careers
. We strongly believe that diversity of experience, perspective and background will lead to a better workplace for our employees and a better product for our customers and members.
Blue Cross and Blue Shield of Nebraska is an Equal Opportunity /Affirmative Action Employer - Minorities/Females/Disabled/Veterans
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