Operations Planning Specialist, PDP Oversight – Monitoring

This is a fully remote position, open to applicants in Tennessee.

📋 Description

• Assist in the daily oversight and monitoring of PDP Enrollment & Premium Billing operations with both vendors and internal/external partners.

• Ensure that processes adhere to both new and existing CMS regulations.

• Track operational metrics, critical volumes, and daily inventory to pinpoint potential issues.

• Conduct monthly reviews of Service Level Agreements and address any issues affecting enrollment and billing operations.

• Manage weekly monitoring tasks, including sample extraction, tracking outcomes and corrective actions, and reporting results to leadership.

• Execute focused monitoring and audits following changes in operational processes.

• Assist with internal, external, and CMS audit activities by conducting quality reviews of universes, samples, and supporting documentation.

• Recognize and communicate trends and issues, and aid in remediation and process enhancements.

• Support AEP and 1/1 Readiness activities associated with enrollment and billing.

• Conduct annual reviews of vendor policies and procedures to ensure alignment with CMS guidelines and company policies.

⛳️ Requirements

• Bachelor's Degree or equivalent experience is required.

• 3-4 years of pertinent experience in Medicare (Part D and/or Part C) or other government programs related to eligibility, premium billing, or healthcare operations.

• Proficiency in Microsoft Word, Excel, Outlook, and PowerPoint.

• Self-motivated individual capable of thriving in a fast-paced and heavily matrixed environment.

• Ability to work independently as well as collaboratively as an effective team member.

• Strong conceptual and analytical abilities.

• Capability to identify connections between interfacing systems and processes.

• Aptitude for identifying issues and managing/executing solutions to resolution.

• Excellent problem-solving skills and attention to detail.

• Ability to assess situations and navigate ambiguity.

• Quick and efficient learner of process and product information.

• Outstanding organizational and written/verbal communication skills.

• Preferred knowledge of advanced Excel, report writing, and analysis activities.

• Experience in enrollment and eligibility processes and process improvement is preferred.

• Preferred experience in Medicare Advantage or Part D.

• Must reside in and be authorized to work in a state where HCSC is permitted to employ remote workers.

• Applicants residing in AK, CA, HI, or NY are not eligible for employment consideration.

🏝️ Benefits

• Health and wellness benefits.

• 401(k) savings plan.

• Pension plan.

• Paid time off.

• Paid parental leave.

• Disability insurance.

• Supplemental life insurance.

• Employee assistance program.

• Paid holidays.

• Tuition reimbursement.

• Other incentives.

• Annual incentive bonus plan.