Base pay is influenced by several factors including a candidate’s qualifications, relevant experience, and anticipated contributions to meet the needs of the business, along with internal pay equity and external market-driven rates. The salary range displayed has not been adjusted for geographical location. This range has been created in good faith based on information known to Capital Blue Cross at the time of posting and may be modified in the future. Capital Blue Cross offers a comprehensive benefits packaging including Medical, Dental & Vision coverage, a Retirement Plan, generous time off including Paid Time Off, Holidays, and Volunteer time off, an Incentive Plan, Tuition Reimbursement, and more.

This position is responsible for supporting the overall success of the Government Programs (GP) Division; supporting the implementation of new products and benefit enhancements of existing products. Also responsible for assisting in the development of new operational workflows and improving existing processes. Supports Business Owners and leadership of GP with implementation cycles, updating/tracking annual timelines. Provides oversight of operational support systems in order to meet GP performance goals, ensure compliance accuracy, and ensure products meet requirements/expectations of external (regulators, providers, members, vendors) and internal customers. 

Primary responsibilities include oversight of implementation activities from CMS and state application and regulatory filings through product launch and the entire product life cycle, as well as ongoing management of the GP product portfolio. This function also includes resolution of operational issues associated with product and account set up, ensuring products are functioning properly within existing systems (FACETS, PBM, Sales systems, etc.), implementing guidance changes, and coordinating internal process communications.

This individual will work on project teams with individuals with diverse levels of knowledge from throughout the organization and will use creativity and initiative in providing solutions which meet or exceed project objectives.

The position will partner with GP Management and Sales, Marketing, Stars, Clinical, Pharmacy, Actuarial, Legal, Compliance, Operational Departments and other subject matters experts throughout the enterprise to ensure effective product offerings are identified, filed, and implemented to meet the division's strategic priorities including targeted membership growth, profitability, and Stars/member retention goals.

• Participate in large, complex projects and monitor business plans to assist in achieving key business objectives and ensuring regulatory/corporate deadlines are met.
• Coordinate system changes related to benefit configuration and testing between Product, Medical Management, and IT&D teams. Discuss system update recommendations with leads and management of GP for testing and implementation.
• Participate on cross-functional teams to support annual planning and implementation cycles, and assess operational feasibility of new and enhanced Medicare products.
• Monitor regular reporting on operational and vendor performance to ensure CMS and business requirements are met. Incumbent will keep GP management updated on status.
• Incumbent will play a key role in interpreting and understanding CMS guidance and implementing product changes/updates and communicating to internal and external stakeholders on these regulatory updates.
• Participate in cross-segment projects and initiatives that require problem solving, relationship building, influencing and analyzing; including collaborating/implementation of new vendor RFPs, contracts, and oversight.
• Assist with maintaining GP policy compliance training and product services improvement.

Experience:

• Deep understanding of MA products and benefits.
• Minimum three to five years of experience in health insurance organization managing benefits, pricing, and the operational systems that support them.
• Prior experience in compliance, operations, or project management experience is preferred.

Education and Certifications:

• Prefer bachelor’s degree in business, health management, marketing, or communication or equivalent work experience.

Knowledge:

• Knowledge and understanding of Medicare benefits required.

​Skills:

• Proven successful experience leading complex projects, preferably in Government Programs products.
• Effective communication, both written and oral, skills and strong skills with common PC software applications (i.e. Microsoft Office) required.
• Excellent analytical, organizational and project management skills required. Previous experience with the development of project plans and timelines, ability to assess global and operational impacts and define requirements.
• Ability to build successful collaborative business relationships and partner with large cross-functional teams on new product implementations and changes.
• Excellent presentation skills required including presentation development, product training, process improvements, and developing policies & procedures.
• Experience using effective problem solving and decision making techniques to develop recommendations and present to management/stakeholders.
• Position requires strong attention to detail and high level of accuracy.

Physical Demands:

• While performing the duties of the job, the employee is frequently required to sit, use hands and fingers, talk, hear, and see.
• The employee must be able to work over 40 hours per week.
• The employee must occasionally lift and/or move up to 5 pounds.

We recognize that work is a part of life, not separate from it, and foster a flexible environment where your health and wellbeing are prioritized. At Capital you will work alongside a caring team of supportive colleagues and be encouraged to volunteer in your community.  We value your professional and personal growth by investing heavily in training and continuing education, so you have the tools to do your best as you develop your career. And by doing your best, you’ll help us live our mission of improving the health and well-being of our members and the communities in which they live.