Senior Medicare Analyst

Central Coast Salary Range: $84,877 - $123,072 Annually

​​​​​​​While candidates from anywhere in California are welcome to apply, there is a strong preference for those who reside on the Central Coast (Ventura, Santa Barbara, San Luis Obispo, Monterey, and Santa Cruz Counties). This role may offer opportunities for remote work; however, familiarity with and proximity to our local customers is valued.

Job Summary

The Senior Medicare Analyst plays a vital role in supporting the Medicare Director with the operational, regulatory, and product development aspects of CenCal Health CareConnect’s Dual Eligible Special Needs Plan (D-SNP) Medicare product. This role includes assisting with Medicare product development, such as annual bid preparation, supplemental benefit implementation, and market research. The Senior Analyst will also help manage supplemental benefits administration, monitor and report on program performance, and provide support to the D-SNP Enrollee Advisory Committee (EAC) to improve member engagement and incorporate feedback.

The ideal candidate will have strong analytical abilities, operational experience, regulatory knowledge, and the capacity to collaborate effectively with various departments, vendors, and external agencies.

Duties and Responsibilities

1. Medicare Product and Bid Support
   a. Assist the Medicare Director in the annual Medicare bid process by collaborating with internal teams, including Actuarial, Finance, and Product.
   b. Conduct market research and competitive analysis to identify trends and opportunities for enhancing the D-SNP product.
   c. Support the integration of supplemental benefits, ensuring smooth implementation within plan operations and member communications.
   d. Monitor and analyze bid performance, financial projections, and membership trends to provide valuable insights for leadership decision-making.

2. Supplemental Benefits Administration
   a. Assist with the implementation and ongoing oversight of D-SNP supplemental benefits.
   b. Support the Medicare Director in managing vendor relationships to ensure effective administration of supplemental benefits.
   c. Help develop and maintain performance tracking and reporting systems to evaluate benefit utilization and member engagement.
   d. Collaborate with Provider Services, Member Services, and IT to ensure seamless member access to supplemental benefits.

3. Operations Process Improvement
   a. Assist the Medicare Director in refining D-SNP workflows and operational processes.
   b. Work with internal teams to drive improvements that enhance efficiency and ensure compliance.
   c. Contribute to the development of Standard Operating Procedures (SOPs) and Policies and Procedures (PnPs) as needed.

4. Reporting and Analysis
   a. Assist in generating reports related to membership, supplemental benefit usage, and operational performance metrics.
   b. Track key performance indicators (KPIs) to assess program effectiveness and identify opportunities for improvement.

5. Enrollee Advisory Committee (EAC) Support
   a. Assist the Medicare Director in coordinating and facilitating the Enrollee Advisory Committee (EAC).
   b. Support the development of materials, scheduling of meetings, and logistics for EAC member engagement.
   c. Gather and analyze EAC feedback to inform plan improvements, benefit enhancements, and member experience initiatives.
   d. Work with Member Services, Compliance, and Operations to ensure timely responses to EAC concerns and recommendations.

6. Other duties as assigned

Knowledge/Skills/Abilities

Required:

• Strong critical thinking skills are required for managing Medicare daily operations and supporting annual product development.

• Ability to handle multiple tasks simultaneously and effectively prioritize.

• Demonstrates sound judgment in decision-making within the responsibilities of the role.

• Capable of working independently with minimal supervision.

• Exceptional oral and written communication skills.

Education and Experience

Required:

• Bachelor’s Degree in Healthcare Administration, Public Health, or a related field, or 2-3 years of experience in health administration, managed care, or a similar field related to Medicare D-SNP product development and oversight preferred.

• Data collection and analysis experience

• Knowledge of and ability to utilize conflict resolution and problem-solving techniques.

• Experience managed care setting with Medicare subject matter expertise.

• Knowledge of Microsoft Word, Windows, Microsoft Excel, Adobe Acrobat DC Pro or similar spreadsheet, and Microsoft Access or similar databases.