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Director of Medicare

The Director of Medicare oversees the development, management, and enhancement of Health New England’s Medicare line of business product lifecycle. A very strategic and forward-thinking subject matter expert role on Medicare regulatory requirements who liaises with internal and external business leaders to gain awareness across all channels as needed to build out multi-year expansion, synergies, and growth strategy.

Partners with organizational leadership to identify, track, manage and support successful design, filing, and implementation, Medicare Advantage and Medicare Supplement health insurance products. The Director plays a crucial role in setting the vision and growth strategy across all distribution channels (considering both product and strategic footprint implications).

Essential Functions:
• Lead Health New England’s Medicare line of business growth opportunities within existing markets, strategies for growth, as well as assess deeper partnership opportunities with customers (prospective and current).
• Collaborate with distribution and matrix partners (Marketing, Communications, IT, Network Contracting, Risk Adjustment, Medical/Health Services, and Finance) to develop a multi-year growth expansion plan across Sales channels – Brokers, Exchanges, Telesales Reps, Internal Sales team.
• Identify, manage, and develop Health New England’s strategic plans to mitigate risks in operational processes that could impact the health plan effectiveness in satisfying regulatory deadlines and other legal requirements.
• Creatively and effectively manage competing priorities across various departments to ensure that key deliverables are completed on time, and dependent tasks are not unnecessarily delayed.
• Oversee Health New England's Medicare Steering Committee, bid process, assigned audits, and regulatory reporting.
• Leads regular work stream meetings to ensure that processes are on track and crucial lines of communication remain open.
• Review and respond to analytics to gain insights on performance and opportunities across the designated market to define and redefine strategy, including opportunities for channel diversification to increase growth.
• Work closely with Revenue, Enrollment and Risk Adjustment Directors to oversee and manage the revenue stream and how it interacts with the current and future strategy for the LOB.
• Serves as the liaison between Customer Experience and distribution for customer retention strategies, as they are a critical component of growth.
Minimum Requirements: State the specific knowledge, skills, abilities, and experience required to perform the essential functions listed above. Include particular degrees, licenses, certifications, etc. if they are a minimum requirement for the job.

Minimum Requirements:
Bachelor's degree with a minimum of 5 years of relevant experience or an advanced degree with a minimum of 3 years of relevant experience or a combination of education and experience. In addition:
• Expert-level knowledge of Medicare programs, regulations, and operations.
• Strong relationship builder.
• Strong leadership, communication, presentation, and organizational skills.
• Strong networking skills and strategic mindset with a keen focus on profitable growth.
• Expert level of knowledge of compliance procedures and regulatory requirements.
• Ability to learn quickly, adapt to change in a fast-paced environment.
• Expert knowledge and ability to work in a team & business partnership environment.
• Knowledge of (industry) landscape, (trends, and critical competitor strategic direction).

Supervisory Responsibilities:
Medicare Sales Manager
Medicare Program Manager
Government Program Innovation Manager

Time:  Full time
Salary:  Salary
Category:  Operations

Updated: 6/12/2020 9:19:56 AM

Job Contact:
Elisa Rose

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1 Monarch Pl
Springfield, MA 01144-1500