Senior Program Manager – Medicare Operations

This is a fully remote position, open to applicants in California, +25 more states.

📋 Description

• Oversee operations for the Federal Employee Program Medicare Advantage EGWP line of business.

• Supervise daily operational workflows that support Medicare products and services.

• Ensure adherence to operational and regulatory standards set by FEP, OPM, CMS, and EGWP policies and procedures.

• Drive operational efficiencies and spearhead continuous improvement initiatives.

• Support cross-functional operational implementation efforts to enhance member and provider experiences.

• Collaborate with operations, Compliance, Product, Clinical, Network, and Inter Plan & Products teams throughout the product lifecycle.

• Manage business requirements, system implementations, user acceptance testing (UAT), and change management processes.

• Guarantee compliance with CMS standards and maintain audit readiness.

• Monitor operations pre- and post-launch, identify execution gaps, and facilitate in-year corrections.

• Oversee product implementation and operational readiness, including compliant benefit structuring.

• Assist enrollment, member services, provider network operations, Annual Notice of Change (ANOC)/Evidence of Coverage (EOC) planning, and member experience initiatives.

• Contribute to strategic planning, develop multi-year operational roadmaps, and optimize processes using Lean Six Sigma and industry benchmarking.

• Manage vendor relationships, contracts, and requests for proposals (RFPs); represent Medicare Advantage operations in governance forums and with CMS.

• Compile and disseminate operational performance reports, including key performance indicators (KPIs), service level agreements (SLAs), regulatory, and operational metrics, to BCBSA leadership.

• Coordinate with FEPOC Operations, present recommendations to leadership, and mentor operational staff.

⛳️ Requirements

• Bachelor’s degree in Healthcare, Business Administration, Public Health, or a related field; or equivalent experience.

• Over 8 years of experience in Medicare/Medicare Advantage Operations, healthcare operations, and health insurance or managed care.

• Extensive knowledge of Medicare Advantage, Part D, and CMS regulations.

• Proven experience leading or supporting large, cross-functional programs/projects, including collaboration with third-party administrators (TPAs) and business process outsourcing (BPO) organizations.

• Familiarity with core processing platforms such as Facets, HealthEdge, and QNXT.

• Strong analytical abilities to interpret utilization data, perform competitive benchmarking, and analyze quality/Stars metrics.

• Exceptional written, oral communication, and presentation skills.

• Capacity to create and present executive-level materials and advocate for product initiatives to senior stakeholders.

• Proficient in Microsoft Office Suite (Word, Excel, PowerPoint).

• Knowledge of project management tools and data visualization software.

• Excellent stakeholder management and relationship-building capabilities.

• Ability to influence without direct authority across Legal, Compliance, Actuarial, Clinical, and Operations functions.

🏝️ Benefits

• Annual bonus incentive pay.

• Paid time off.

• 11 holidays.

• Medical insurance.

• Dental insurance.

• Vision insurance.

• Generous 401(k) matching.

• Lifestyle spending account.

• Additional benefits available to eligible employees.