Note: The job is a remote job and is open to candidates in USA. Blue Cross Blue Shield Association is seeking a Medicare Operations Senior Program Manager to oversee operations management for the Federal Employee Program Medicare Advantage EGWP line of business. The role manages product implementation, regulatory compliance, operational readiness, continuous improvement, performance reporting, stakeholder relationships, and cross-functional initiatives supporting member and provider experiences.
Responsibilities
- Manages business requirements, system implementations, UAT, and change management in partnership with the FEP Operations Center and cross-functional stakeholders. Ensures adherence to FEP program and ITS processes/procedures and applies deep Medicare Advantage regulatory and operational expertise to ensure CMS compliance and audit readiness
- Manages pre/post-launch operational monitoring, identifies execution gaps, and drives in-year corrections to maintain product integrity and compliance
- Relationship management skills to build and maintain a positive, collaborative working relationship across various internal and external functional areas/stakeholders. Establish cohesive relationships and influence decisions without having a direct functional reporting structure. Build trust, exhibit sense of urgency, drive consensus in resolving conflicts and decision making. Resolve or escalate issues, propose alternatives and set or manage expectations in a timely fashion
- Manages product implementation and operational readiness as directed by product development team in ensuring benefit builds at the operations and implementation partner level align precisely with approved CMS-compliant specifications. Support enrollment, member services, provider network operations, ANOC/EOC planning, and member experience initiatives
- Supports Product Development team with strategic planning, multi-year operational roadmaps, and process optimization using Lean Six Sigma and industry benchmarking. Manages vendor relationships, contracts, and RFPs; represent MA operations in governance forums and with CMS
- Manages collating MA product operational performance reporting including all applicable KPIs, SLAs, regulatory, and operational reporting metrics and appropriately distributes to BCBSA leadership
- Serves as a liaison and communicator to FEPOC Operations team, presenting recommendations to leadership and mentoring operational staff
Skills
- • Required BS in Healthcare, Business Administration, Public Health, or related field; or equivalent experience
- • Required 8+ Years experience in Medicare/Medicare Advantage Operations, healthcare operations, and health insurance or managed care
- • Deep knowledge of Medicare Advantage, Part D, and CMS regulations
- • Experience leading/supporting large, cross functional programs/projects, including working with TPAs/BPOs
- • Experience working with core processing platforms like – Facets, HealthEdge, QNXT etc
- • Strong analytical skills with ability to interpret utilization data, competitive benchmarking, and quality/Stars metrics to drive benefit enhancement decisions
- • Excellent written, oral communication, and presentation skills; proven ability to develop and deliver executive-level materials and represent product initiatives to senior stakeholders
- • Proficiency in Microsoft Office (Word, Excel, PowerPoint); familiarity with project management tools and data visualization platforms
- • Strong stakeholder management and relationship-building skills with the ability to influence without authority across Legal, Compliance, Actuarial, Clinical, and Operations functions
Benefits
- Annual bonus incentive pay
- Paid time off
- 11 holidays
- Medical/dental/vision insurance
- Generous 401(k) matching
- Lifestyle spending account
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