Impress employers and recruiters.
Choose from hundreds of resume examples.
Impress employers and recruiters.
Choose from hundreds of resume examples.
Target Resume Now
Tailor your resume to this Medicare Segment Manager role.
Rezi rewrites your resume against company's job description. Free.
Tailor your resume to this Medicare Segment Manager role.
Rezi rewrites your resume against company's job description. Free.
Don't guess if your resume is good enough.
See how it scores against the Medicare Segment Manager posting at company — free, in seconds.
Don't guess if your resume is good enough.
See how it scores against the Medicare Segment Manager posting at company — free, in seconds.
About the Role
This position supports Medicare line of business strategy and execution, ensuring Medicare products and programs are administered according to benefit design, regulatory requirements, and strategic objectives. The role is accountable for service and operational requirements and requires knowledge of Medicare Advantage, Medicare Supplement, Part D Prescription Drug Plans, and Dual Eligible products.
Responsibilities
- Develop strategic, operational, and tactical business plans to achieve business goals for Medicare lines of business.
- Evaluate new market opportunities and build necessary business cases.
- Conduct evaluations and assessments of operations to identify root causes of noncompliance and customer dissatisfaction.
- Consult with team members and stakeholders to streamline system operations and processes.
- Plan, develop, and implement special projects and initiatives to support line of business objectives.
- Encourage innovation, process improvements, and personal development within functional business areas supporting Medicare products.
- Develop and maintain relationships across the enterprise to promote consistent strategic priorities.
- Serve as a regulatory liaison to NYS, CMS, or BCBSA as needed.
- Collaborate with cross-functional teams to ensure alignment with line of business objectives, compliance, operational performance, and process improvement.
- Ensure cross-functional integration of strategies with key internal areas including Marketing, Operational Excellence, Population Health Engagement, Finance, Provider Contracting, Compliance, and Enterprise Information Technology.
- Represent Medicare on key cross-functional committees and projects.
- Manage maintenance of business process work item deliverables.
- Solicit direct customer feedback through forums and activities.
- Interpret complex government regulations and identify necessary next steps.
- Engage in issue identification and problem-solving to identify and resolve improvement opportunities.
- Serve as a corporate resource for Medicare, providing subject matter expertise.
- Act quickly to continuous changes and challenges in the regulatory environment.
- Work closely with other departments for input and integration, ensuring all perspectives are considered.
- Develop processes and timelines to incorporate planning and execution of strategies across departments.
- Remain current on evolving market dynamics within the Medicare segment and connect trends to line of business objectives.
- Ensure awareness of market dynamics among key business partners.
- Demonstrate high standards of integrity by supporting the company's mission and values.
- Adhere to the Corporate Code of Conduct and lead to the company's values and beliefs.
- Maintain high regard for member privacy in accordance with corporate privacy policies and procedures.
- Maintain regular and reliable attendance.
- Perform other functions as assigned by management.
Requirements
- Bachelor’s degree in health administration, marketing, business administration or related field.
- Minimum of six years progressive health plan operations experience.
- Strong leadership and/or management experience.
- Strong expertise and background dealing with regulatory and accreditation agencies such as NCQA, CMS, Federal & State agencies including DOH, Dept. of Finance Services.
- Remain current on all relevant regulatory requirements.
- Strong process and program management skills.
- Strong analytical, creativity, and initiative in problem solving and solution identification.
- Strong facilitation skills and follow-through.
- Project management experience required.
- Must be a critical thinker.
- Must possess effective negotiation skills in dealing with middle and senior management levels.
- Must be self-motivated and a self-starter, able to work independently at times without detailed direction.
- Must possess strong computer skills, including MS Word, Excel and PowerPoint.
- Must possess strong, demonstrated analytical ability, strategic thinking, and creativity.
- Must possess a positive attitude, strong work ethic and highly effective communication skills.
- Must be capable of establishing effective relationships with all levels of representation throughout the divisions including senior management to execute cross-divisional initiatives.
- Ability to travel across the health plan service regions as needed.
Skills
- Medicare Advantage
- Medicare Supplement
- Part D Prescription Drug Plans
- Dual Eligible products
- MS Word
- MS Excel
- MS PowerPoint
- Analytical ability
- Strategic thinking
- Creativity
- Communication skills
- Negotiation skills
- Facilitation skills
- Project management
Location
- Travel across health plan service regions
Work Type
- Remote work may be possible
Experience Level
- Minimum of six years progressive health plan operations experience
- Strong leadership and/or management experience
Education Level
- Bachelor's degree in health administration, marketing, business administration or related field
Salary/Compensations
- Minimum: $79,068 - Maximum: $142,322
Benefits
- Participation in group health and/or dental insurance
- Retirement plan
- Wellness program
- Paid time away from work
- Paid holidays
About the Company
- Lifetime Healthcare Companies
Equal Opportunity
- All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.