Medicare Operations Program Manager

Blue Cross Blue Shield of Rhode Island   •  

Providence, RI

Industry: Accounting, Finance & Insurance


5 - 7 years

Posted 94 days ago

This job is no longer available.

Job Description

Manage and organize operational aspects of the delivery of the department portfolio of projects specific to Medicare Operations. Key role in transformational efforts to define new department processes, policies and regulations. Provide vendor management for key systems. Provide oversight of the Medicare call center support suite of services, including quality, knowledge management, reporting, and workforce program. Work as a liaison between BCBSRI and the delegated entity performing the functions.


  • Manage and organize operational aspects of the delivery of the department's portfolio of projects.
  • Analyze and identify problems, risks, and issues across Medicare Operations regarding the delivery of projects, processes, policies, and regulations.
  • Review project deliverables; collaborate with stakeholders to ensure that all deliverables are accurately completed and meet intended quality.
  • Create and maintain department processes, policies, and regulations.
  • Responsible for department-level Risk and Compliance practices and reporting, including, but not limited to, CMSreporting. Ensure corrective actions plans are adequately designed and are closed in a timely manner.
  • Design and implement the monitoring program for Medicare Advantage operational areas specific to enrollment and call center functions.
  • Manage relationships with partners, both internal and external; performs or assists in coordination of compliance training-related programs.
  • Monitor Stars measures.
  • Oversee delegated vendors and provide guidance throughout the auditing, monitoring, and ad hoc compliance oversight processes.
  • Oversee the Medicare contact center, including workforce, quality, knowledge management, and Reporting.
  • Develop and maintain positive working relationships with stakeholders.
  • Guide and mentor less experienced members of the team and orient new associates.
  • Remain aware of industry changes and/or trends and be able to understand how these impact the oversight of operations.
  • Perform other duties as assigned.


Minimum Education and Experience:

  • Bachelor's degree in Business Administration, Business Management, or related field; or an equivalent combination of education and experience.
  • Five to seven years of professional experience in a combination of operations, training and knowledge management, and vendor management.

Preferred Education, Additional Qualifications, and Experience:

  • Knowledge of Medicare regulatory guidelines.
  • MBA, BS in MIS.
  • Experience leading workshops and meetings comprising managers from different departments.
  • Established track record of analyzing and improving enterprise processes.


Required Knowledge, Skills, and/or Abilities:

  • Advanced analytical skills with the ability to interpret and synthesize complex data sets.
  • Strategic and critical thinking skills.
  • Strong analytical skills.
  • Strong business acumen and political savvy.
  • Strong negotiation skills.
  • Strong written and verbal communication skills.
  • Strong problem-solving skills.
  • Ability to work effectively with a wide variety of people in individual and group settings.
  • Strong organizing skills with the ability to prioritize and respond to shifting deadlines.
  • Strong time management skills.
  • Ability to manage diverse and deadline-oriented workflow.

Job ID 660