Company Statement

Connecticare is a leading health plan in the state of Connecticut and a subsidiary of EmblemHealth, a health and wellness company that provides insurance plans, primary and specialty care, and wellness solutions.  WellSpark is a digital wellness company and national subsidiary of EmblemHealth that offers a full suite of products and solutions to reward people for healthy behaviors.

 

To protect the health and safety of our workforce, members, patients, and the communities we serve, the EmblemHealth family of companies require all new employees to be fully vaccinated for COVID-19. Exemption/reasonable accommodations may be granted because of 1) a qualifying medical condition or disability that makes getting the vaccine unsafe for the individual, or 2) objection on the basis of sincerely held religious beliefs and/or practices.
 

Medicare Product Manager

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Manager & Professional
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EmblemHealth
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Oversee and implement the ongoing management of Medicare plan design and benefit changes as they impact EmblemHealth and CCI operational departments.  Manage multiple Medicare operational processes and functions, including: the bid submission support, marketing materials, regulatory mailings and Plan website. Work closely with Medicare leaders in the design of products, relying on industry research, historical product performance, and marketplace trends.

Responsibilities:

  • Develop and maintain an in-depth knowledge of Medicare and Medicaid requirements and regulations that influence Medicare and dual product development and administration, including Call Letter, bid submission requirements, HPMS memos, other federal and state guidance.
  • Serve as the subject matter expert and lead for marketing material review process to ensure product information is communicated accurately and in compliance with federal and state requirements.
  • Manage the benefit documentation process, Medicare benefit and product tasks and projects. 
  • Track and report the status of tasks and deliverables, as determined by the Medicare Product Implementation Leader and Government Products management team. 
  • Serve as Medicare subject matter expert and provide benefit implementation support to internal and external stakeholders.
  • Research and respond to benefit and product related complaints and inquiries as needed. 
  • Identify trends and gaps in operational processes and make actionable recommendations to improve member experience and product delivery.
  • Monitor progress to ensure timely and accurate completion of business requirements, user acceptance testing and related issue resolution.
  • Coordinate issue management, including intake, triage, monitoring of issue resolution.
  • Develop resource management tools to schedule work, monitor progress and report status.    
  • Manage the tasks and deliverables of the plan renewal that are assigned to the Medicare Product Team to ensure timely and accurate completion.  
  • Assist with defining the scope, tasks, timeline, deliverables and milestones of the annual Medicare Renewal. 
  • Advise the project team on the intended operational outcome of Medicare strategic and regulatory changes by attending all workgroup meetings.  
  • Collaborate with the Medicare Implementation Leader and AVP of Product Administration to ensure issues are adequately defined, assigned and tracked to resolution; risks are accurately documented and mitigated.       
  • Identify Medicare product enhancements/benefits requiring filing modifications and assist in completing the annual Medicare bid filing and validation. 
  • Prepare and conduct enterprise product information sessions and annual training.     
  • Coordinate and manage quality control activities related but not limited to benefits and bid documentation, other processes owned/performed by the Medicare Team.    
  • Document and coordinate the periodic review and update of Operational Policies and Procedures for processes owned/performed by the Medicare Team.    
  • Develop informational presentations as requested by the Medicare Implementation Leader and AVP of Product Administration: provide updates, train and/or communicate status pertaining to Medicare Products and the activities of the Medicare Team. 
  • Collect, compile and present data as requested in support of the Medicare Products planning process.
  • Perform other functions as directed, assigned, or required.  Regular attendance is an essential function of the job.

Qualifications:

  • Bachelor’s Degree
  • 5 – 8+ years relevant professional work experience (R)
  • Experience in managing Medicare related projects/processes on a large (divisional/enterprise level) scale (R)
  • Knowledge of Medicare Managed Care (R)
  • Knowledge of Health Insurance Operations, including: Customer Service, Enrollment, Benefits, Claims and Enrollment (R)
  • Microsoft Office Tools including: Outlook, Excel, Word, Powerpoint (R)
  • Communications skills (verbal, written, presentation, interpersonal) with all types/levels of audience (R)
  • Experience with Microsoft Project and Visio a plus (P)

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