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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in Medicare line of business strategy, regulatory compliance, and operational excellence. Proven ability to develop strategic business plans, manage cross-functional collaboration, and drive process improvements while maintaining strong relationships with regulatory agencies.
Highest-signal resume keywords
Medicare Line Of Business StrategyRegulatory ComplianceProject ManagementProcess ImprovementHealth Plan Operations Experience
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Business AdministrationHealth AdministrationRegulatory RequirementsProgram ManagementAnalytical SkillsCritical ThinkingNegotiation SkillsComputer SkillsStrategic ThinkingCreative Problem-Solving
Soft Skills
LeadershipFacilitation SkillsEffective CommunicationRelationship BuildingPositive Attitude
Tools & Technologies
MS WordMS ExcelMS PowerPoint
Industry Keywords
CMSNCQAFederal AgenciesState AgenciesHealth Plan OperationsAccreditation AgenciesCustomer SatisfactionMarket OpportunitiesOperational ExcellencePopulation Health Engagement
About the role
Key responsibilities & impact- Support Medicare line of business strategy and execution
- Ensure Medicare products and programs comply with approved benefit design, regulatory requirements and strategic objectives
- Develop strategic, operational and tactical business plans for Medicare lines of business
- Evaluate new market opportunities and build business cases
- Assess operations to identify root causes of noncompliance and customer dissatisfaction
- Streamline systems and processes to improve business effectiveness and efficiency
- Plan, develop and implement special projects, initiatives and activities
- Encourage innovation, process improvements and personal development
- Develop and maintain enterprise relationships
- Serve as regulatory liaison to NYS, CMS or BCBSA as needed
- Collaborate with cross-functional business and project teams
- Ensure integration with Marketing, Operational Excellence, Population Health Engagement, Finance, Provider Contracting, Compliance and Enterprise Information Technology
- Represent Medicare on cross-functional committees and projects
- Manage business process work-item deliverables and solicit customer feedback
- Interpret complex government regulations and identify next steps
- Identify and resolve improvement opportunities
- Serve as a corporate Medicare subject-matter expert
- Monitor regulatory changes and evolving Medicare market dynamics
- Support the Lifetime Healthcare Companies’ mission, values, Code of Conduct and privacy policies
- Perform other functions as assigned by management
Requirements
What you’ll need- 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
- Current knowledge of relevant regulatory requirements
- Strong process and program management skills
- Analytical, creative problem-solving and solution identification skills
- Strong facilitation skills and follow through
- Project management experience
- Critical thinking and effective negotiation skills
- Ability to work independently at times without detailed direction
- Strong computer skills, including MS Word, Excel and PowerPoint
- Strong demonstrated analytical ability, strategic thinking, creativity, positive attitude, strong work ethic and highly effective communication skills
- Ability to establish effective relationships with all levels of representation, including senior management
- Ability to travel across the health plan service regions as needed
- Regular and reliable attendance
Benefits
Comp & perks- Group health and/or dental insurance
- Retirement plan
- Wellness program
- Paid time away from work
- Paid holidays
- Potential remote work on a case-by-case basis