Senior Health Plan Product Specialist (Remote)

Company: Commonwealth Care Alliance
Location: Indianapolis
Posted on: May 15, 2022

Job Description:

The Senior Health Plan Product Specialist is a key role that supports CCA efforts in end-to-end development of new product initiatives, annual review of current product filings, and compliance with and promotion of accurate member collateral for all CCA product offerings. Using knowledge of Medicare, Dual Eligible Special Needs Plans, Medicaid, other state and federal regulatory requirements, this position ensures CCA's adherence to relevant and applicable regulatory requirements, including, but not limited to yearly memos on the annual bid process, annual bid guidelines and training, and Medicare Communication & Marketing Guidelines (MCMG). This person is knowledgeable of both the Medicare and Medicaid plan designs, and serves as an internal resource for benefit interpretation, serving a key role in the operational implementation of both benefits and other programmatic changes. The position is key to effectively managing the accuracy of benefits offered to CCA membership, both through annual submissions to regulators, and how they are communicated through Plan materials in collaboration with Marketing and other key internal stakeholders. The Product Program Specialist will be responsible for specific products or states as determined by the needs of the organization.

What we are looking for

Bachelor's degree in business administration, health care administrations, public health, or related field.
OR
Equivalent experience (at least 5 years), specific to the development of MAPD products

Required:

Two or more years of previous professional experience in managed care setting with a focus on benefit design, product administration and regulatory compliance with Medicaid and Medicare Communications & Marketing Guidelines.
Proficiency in MS Word, Excel, and PowerPoint.
Interest in developing a robust understanding of healthcare landscape.
Knowledge and understanding of Medicare, federal and state rules, and regulations.
Knowledge of the Medicare Communication & Marketing Guidelines.
Ability to research regulations and guidelines.
Strong organizational skills and attention to details.
Excellent presentation, writing and editing skills.
Ability to work across discipline and lead teams.
Ability to communicate complex issues and problems.
Demonstrates excellent judgment in decision-making and problem-solving skills.
The candidate must be able to work independently and with flexibility.
Ability to identify operational interdependencies.
Preferred:
Working knowledge of Adobe products and their use in editing marketing materials.
Medicare bid software and HPMS experience.
Experience working with Dually Eligible Plans.
Project management experience.
Experience with Medicare Advantage market.
Healthcare experience.

What you will be doing

Participate in the year-round Product strategy process for current business lines (including, but not limited to, Medicare Advantage, Senior Care Options, One Care).
Contribute to researching opportunities for new product features, assisting with the cross-functional assessment to understand the financial, strategic, and operational implications, as well as gaining buy-in from different functional areas.
Maintain and continually refresh knowledge of the Medicare Advantage market, including experience with developing competitive analyses.
Play a supporting role in the end-to-end assessment and development of new product initiatives
Participates in the annual bid and plan benefit package submission process, as well as supporting strategic benefit design efforts.
Participate in interdepartmental projects pertaining to product benefits, including pharmacy and Ancillary benefit designs.
Responsible for regularly reviewing Medicare transmittals, updates to the Medicare Managed Care Manual, the Benefit Policy Manual or any other published Medicare or Medicaid documentation related to the product benefits.
Supports and creates training activities to explain new product, changes to benefits annually and ad hoc as required.
Evaluates member materials to ensure accuracy is descriptions of member benefits.
Supports and contributes to the maintenance of product educational materials for staff, including, but not limited to, quick guides, a member benefit tool for member-facing staff and intranet site(s)
Support Director of Product in resolving day-to-day issues impacting product performance, including internal business processes as well as external vendors
Develop and maintains Standard Operating Procedures relative to the creation, approval, and distribution of all regulated member materials.
Work with the technical infrastructure team to develop and deploy effective methods to process document creation, approval, and storage.
Serve as a resource on CMS/federal or state issued benefit coverage related legislation.
Serve as a contact for products and benefit interpretation questions.
Support creation of the Evidence of Coverage, Annual Notice of Change, Summary of Benefits, and other regulated documents ensuring compliance with regulatory and accrediting bodies.
Presenting complex and detailed product information in an understandable and accessible way to staff, including leadership

Keywords: Commonwealth Care Alliance, Indianapolis , Senior Health Plan Product Specialist (Remote), Healthcare , Indianapolis, Indiana