Medicare Product Manager at Emblem Health in Farmington, Connecticut

Job Description:

Oversee and implement the ongoing management of Medicare plan design and benefit changes as they impact EmblemHealth and CCI operational departments. Manage multiple Medicare operational processes and functions, including: the bid submission, marketing materials, regulatory mailings and Plan website. Work closely with Medicare leaders in the design of products, relying on industry research, historical product performance, and marketplace trends.

Responsibilities:

• Evaluate the resource needs of the Medicare Product Team, including resources for: the daily marketing material review process, the annual regulatory mailing process, the bid submission process, the benefit documentation process, and participation on corporate and departmental projects as assigned.
• Assign resources to routine tasks and projects and monitor progress to ensure timely and accurate completion.
• Track and report the status of tasks and deliverables, as determined by the Director of Medicare Products.
• Coordinate issue management, including: intake, triage, monitoring of issue resolution.
• Develop resource management tools to schedule work, monitor progress and report status.
• Manage the tasks and deliverables of the Annual Renewal that are assigned to the Medicare Products Team to ensure timely and accurate completion.
• Assist the Director of Medicare Products with: defining the scope, tasks, timeline, deliverables and milestones of the annual Medicare Renewal.
• Advise the project team on the intended operational outcome of Medicare strategic and regulatory changes by attending all workgroup meetings.
• Collaborate with the Annual Renewal Project Manager to ensure: issues are adequately defined, assigned and tracked to resolution; risks are accurately documented and mitigated.
• Manage the annual Medicare bid submission process, including: collaboration with other departments to obtain bid information (i.e. Actuarial, Pharmacy, Provider Data Reporting, Medical Management, Benefits, Sales, Legal, Operations, etc.)
• Identify Medicare product enhancements/benefits requiring filing modifications and complete the annual Medicare bid filing and validation.
• Enter all bid data, serve as information system superuser and manage the software data entry of all plans for accuracy within designated deadlines; work cross-functionally to ensure timeliness and precision of information.
• Coordinate and manage quality control activities related to: the Annual Regulatory Mailings, the Annual Bid Submission, benefits and bid documentation, other processes owned/performed by the Medicare Products Team.
• Document and coordinate the periodic review and update of Operational Policies and Procedures for processes owned/performed by the Medicare Product Team.
• Develop informational presentations as requested by the Director of Medicare Products to: provide updates, train and/or communicate status pertaining to Medicare Products and the activities of the Medicare Product Team.
• Collect, compile and present data as requested in support of the Medicare Products planning process.
• Regular attendance is an essential function of the job. Performs other duties as assigned or required.

Qualifications:

• Bachelor’s Degree required
• 5-8 years relevant experience required
• Experience in managing Medicare related projects/processes on a large (divisional/enterprise level) scale required
• Knowledge of Medicare Managed Care required
• Knowledge of Health Insurance Operations, including: Customer Service, Enrollment, Benefits, Claims and Enrollment required
• Microsoft Office Tools including: Outlook, Excel, Word, Powerpoint required
• Experience with Microsoft Project and Visio a plus; preferred

Additional Information

• Requisition ID: 210G5