Accident Fund Holdings, Inc
Posted Under: Southfield, Michigan jobs in Executive; Executive jobs
Posted On: 2020-02-15 00:00:00
The Manager, Medicare Product Management supports Medicare Advantage product management and implementation within the Senior Health Services (SHS) segment. This position is responsible for working with BCN, BCBSM, and SHS employee's leadership at all levels to deliver a quality and financially viable product portfolio which realizes targeted membership growth and achieves target margins. This position supports the Managing Director and drives product management and implementation alignment throughout BCN, BCBSM, and SHS. This role has Product coordination tasks including leading and/or participating on product ideation and implementation work groups, assessing new opportunities in marketplace, identifying and championing resolution of products issues, including tracking of issues related to implementation and product rules, facilitating meetings necessary to resolve issues, and product performance status reporting, and post implementation product monitoring. This position is responsible to manage staff and externally, is expected to be aware of industry trends, landscape environment, and any market influences that may affect BCN, BCBSM and/or SHS in its quest to become a best-in-class organization/segment. RESPONSIBILITIES/TASKS: Leads and participates in product implementation work groups and complete tasks as assigned. Leads the development and implementation of new products or changes to existing products and ensures business leaders and process owners are aligned and timely in submission of CMS bid deliverables required for product pricing. Manages project plans and deliverables and provides oversight to ensure infrastructure and deliverables are in place for new product launches and existing products annual changes. Supports annual product implementation and tracks and reports issues related to new product implementation and ongoing product guidelines. Champions resolution of any issues identified regarding the product. Monitors Individual Medicare Advantage products, enrollment, and competitors to assess market place success and identify challenges/opportunities. Facilitates meetings to ensure timely deliverables related to CMS bid submission, and implementation of new and renewing products. Champions with business partners including Health Care Values (HCV), Clinical, Actuarial and Part D Pharmacy on CMS Value-Based Incentive Design (VBID) and ensures product components are timely and accurately implemented seamlessly as part of MA HMO product portfolio. Supports MA member-material, compliance oversight review, and submission to CMS, ensuring material accuracy from a compliance, product, and benefit perspective and provides managerial review and approval of member pre-enrollment and post-enrollment product-related materials for accuracy, as needed. Engages with Marketing Communications in business expectations and member material messaging and strategy. Engages with and supports Market Communications and Sales Marketing in annual advertising and direct mail strategy. Resources and provides business oversight for MA member materials including Blue Relay entry of business requests, monitors blue relay deliverables and escalation of deliverables that are not meeting business expectations from a timeliness or quality perspective. Responsible for management oversight of CMS Chapter 3 Medicare Marketing Guidelines and internal collaboration to ensure on-going alignment and best practices. Serves as a subject matter expert of CMS Chapter 4 which regulates Medicare Advantage benefits and product design requirements for both Individual and Group products and champions development of the guidelines related to CMS guidance on existing and new products and product-related bid requirements, certificates, and riders. Provides business oversight and expertise of new member materials development that include product information, certificate, and rider language when appropriate, and ensures they have met legal and compliance approval and have been filed with the CMS or DFIS, as appropriate. Manages and/or provides analytical support to various projects that impact members including, annual member materials on-line requirements, promoting "Go Green" member communications, etc. as needed. ? General oversight of MA Part C EOB including participation in monthly roadmap meeting, identifying enhancements, assisting in deficiency resolution, performing in-process quality review, and providing CMS regulatory input. Participates in monthly Provider Communications Oversight Team meetings identifying MA updates impacting the provider community and leads the update of the MA sections of the provider manual both ongoing and annually. Oversees annual production of MA out of pocket benefits card. Participates in development of annual departmental budget, monitors budget, and identifies budget discrepancies. Researches cause and makes recommendations. Responsible for balancing workload to optimize the effectiveness of the department. DIRECTION EXERCISED: Directly supervises exempt and non-exempt staff in accordance with company policies and applicable Federal and State Laws. Responsibilities include, but are not limited to, effectively interviewing, hiring, terminating, and training employees; planning, assigning, and directing work; appraising performance; rewarding and counseling employees; addressing complaints and resolving problems; supporting and encouraging the engagement process. This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required. Bachelor's degree in Business, Healthcare, Marketing, or a related field. Relevant combination of education and experience may be considered in lieu of degree. Continuous learning, as defined by the Company's learning philosophy, is required. Certification or progress toward certification is highly preferred and encouraged. EXPERIENCE: Seven years' experience of progressive responsibility in a Project Management environment with demonstrated technical knowledge that provides the necessary knowledge, skills, and abilities required. Three years supervisory or lead experience in Project Management required. Experience in Medicare public and private exchange set up and operations while ensuring CMS and DIFS compliance and experience in Medicare call center operation with knowledge of CMS and DIFS rules and regulations around MA and Medigap product lines is required. Bilingual skills preferred. SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED: Knowledge of tracking and status reporting. Ability to identify and quickly resolve issues which may impede new product implementation and ongoing product performance. Excellent verbal and written communication skills including the ability to conduct presentations and facilitate meetings. Excellent organizational skills with the ability to handle multiple project and timelines. Excellent customer service and interpersonal skills including the ability to interact with internal and external customers and all levels of the organization. Project management and coordination skills. Excellent follow up skills. Demonstrates initiative, ownership, and accountability. Intermediate computer skills (Microsoft Office, Power Point). Must demonstrate leadership ability and team building skills to effectively supervise professional and non-professional staff and interact with all levels of management. Ability to work with and empower others on a collaborative basis to ensure success of unit team. Ability to effectively exchange information, in verbal or written form, by sharing ideas, reporting facts and other information, responding to questions, and employing active listening techniques. Ability to effectively present budgetary and/or cost information and respond to questions as appropriate. Ability to establish workflows, manage multiple projects, and meet necessary deadlines. WORKING CONDITIONS: Work is performed in an office setting with no unusual hazards. Travel is required. The qualifications listed above are intended to represent the minimum education, experience, skills, knowledge and ability levels associated with performing the duties and responsibilities contained in this job description. We are an Equal Opportunity Employer. Diversity is valued, and we will not tolerate discrimination or harassment in any form. Candidates for the position stated above are hired on an "at will" basis. Nothing herein is intended to create a contract.