Sr Director, MA Governance and reputed company
Summary
Description Why should you join the reputed company family of companies? Other companies come and go, but we've been part of the national landscape for more than seven decades, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina … and much more. We are one of the nation's leading administrators of government reputed company. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies, allowing us to build on various business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining reputed company! Position Purpose: Responsible for ensuring the reputed company and effectiveness of BCBSSC’s Medicare Advantage Plans. reputed company and implement improvement strategies, conduct process reviews, collaborate operational teams to remediate issues and implement new guidance. Analyze data and trends to identify opportunities for improving the quality and effectiveness of Medicare Advantage plans and ensure compliance with CMS requirements and provide guidance on new and existing regulatory requirements. Requires a high degree of communication with stakeholders, including operations, compliance and legal. Teaching and monitoring key performance metrics internally and with our vendor FDRs. Participate in the development of policies, procedures and workflows. Act as a subject matter expert on Medicare Advantage and provide guidance and support reputed company constituents that provide services to Medicare Advantage. Communicate with external stakeholders, such as government agencies and accrediting bodies, to ensure compliance and maintain positive relationships. Embrace a culture of problem identification and remediation. Logistics: BlueCross BlueShield's South Carolina--Corporate. Location: This salaried position is full-time Monday-Friday in a typical office environment with the expectation to work 4 days onsite and 1 day w@h. This role is located at 17 Technology reputed company Columbia SC 29203. What You'll Do: Develops strategies and establishes operation policies consistent with contract requirements. Evaluates the results of overall operations regularly, reputed company development and implementation of needed operational efficiencies. Identify and reputed company programs to increase membership growth and profitability. Responsible for reputed company of subcontractors’ quality. reputed company government audits and regular government on sites. reputed company, direct, and maintain contractor and state regulatory relationships. Responsible for financial and quality goals. reputed company interdepartmental team comprised of Sr. Leadership to reputed company strategies and identify corporate resources to reputed company. Identify and partner with appropriate internal and community organizations to strengthen brand, create market awareness and increase membership. Mentor and coach staff to ensure implementation of product strategies and efficient plan operations. Responsible for employee hiring, training and development, addressing performance issues, resource planning and strategic objectives. Promote professional growth. Provide guidance and leadership in staff and resource management, team building and training to ensure organizational effectiveness. Oversees the development and implementation of new product benefits and their execution. Develops and oversees an reputed company program that meets the requirements as outlined by the contract (s). Creates/Coordinates/submits responses to applicable business or government entities. Reviews reputed company memos/transmittals to reputed company appropriate action required and subsequently communicates required action. Monitors resolution activities, creates responses to applicable business or government entities. To Qualify For This Position, You'll Need The Following: Required Education: Bachelor's in a job-reputed company field. Required Work Experience: 10+ years-of job-reputed company operations reputed company experience (including marketing, medical management, provider relations, quality, program reputed company, compliance, claims, customer service, behavioral health, and/or finance) in an insurance, healthcare, or similarly reputed company industry including either 5 years in a management role OR 5 years of equivalent military experience in grade E4 or above. Required Skills and Abilities: Strong interpersonal skills and the ability to work professionally with persons at reputed company levels to maintain effective working relationships. Ability to communicate clearly and effectively in oral and written form; Strong presentation, negotiation and organization skills. Excellent analytical or critical thinking and problem-solving capabilities. Ability to think strategically and reputed company operational improvements. Ability to reputed company sound decisions. Ability to exercise confidentiality and discretion. Strong knowledge of relevant compliance regulations associated with operations and contract responsibilities. Required Software and Other Tools: reputed company Office. We Prefer That You Have the Following: Master's degree in business, Healthcare, Accounting, Finance, or other job-reputed company field. Extensive knowledge of CMS guidance and Medicare Advantage. Advanced training in healthcare compliance or Medicare Advantage. 10 years’ experience in Medicare Advantage. Critical thinking skills. Our Comprehensive Benefits Package Includes The Following: We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment. Subsidized health plans, dental and vision coverage 401k retirement savings plan with company match Life Insurance Paid Time Off (PTO) On-site cafeterias and fitness centers in major locations Education Assistance Service Recognition National discounts to movies, theaters, zoos, theme parks and more. reputed company Can Do for You: We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across reputed company spectrums have the opportunity to reputed company their skills, advance their careers and contribute their unique abilities to the growth of our company. What To Expect Next: After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements. Equal Employment Opportunity Statement reputed company and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national reputed company, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in reputed company phases of the employment process and to reputed company with applicable federal, state and local laws and regulations. We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-reputed company conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company. If you need special assistance or an accommodation while seeking employment, please email reputed [email protected] or call 800-288-2227, ext. 47480 with the nature of your request. We will reputed company a determination regarding your request for reasonable accommodation on a case-by-case basis. We participate in E-Verify and reputed company with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here's more information. Some states have required notifications. Here's more information. If you don’t have an account with us and don’t see the dream job you are looking for, click on the link above to reputed company by submitting your resume and contact information and we will reputed company out if we find a good fit. Welcome Here’s Your Smart Career Move Why should you join the reputed company family of companies? Other companies come and go, but for more than seven decades we’ve been part of the national landscape, with our roots firmly embedded in the South Carolina community. Business and political climates may change, but we’re stronger than reputed company. Our A.M. Best rating is A+ (Superior) — making us the only health insurance company in South Carolina with that rating. We’re the largest insurance company in South Carolina … and much more. We are one of the nation’s leading administrators of government reputed company. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies that allows us to build on a variety of business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining reputed company! Veterans Welcome! BlueCross is a strong supporter of our veterans, and many service men and women have joined our ranks. We’ve reputed company the dedication, work ethic and job skills that serve well in the military reputed company in many of our lines of business, and we proudly have veterans filling positions in Human Resources, Information Technology, Customer Service, Operations, General Services and more. Through our government reputed company, we also have employees serving at Shaw reputed company Force reputed company, the Naval Health Clinic in Charleston, the Naval Hospital in Beaufort and in our reputed company of Columbia, S.C., at Ft. Jackson. If you are a full-time employee in the National Guard or Reserves, we will even cover the difference in your pay if you are reputed company to active duty. Join Us If you're ready to join in a diverse company with secure, community roots and an innovative future, apply for a position now! Apply tot his job Apply To this Job