Lead Analyst - COB Part C/D and Recovery - FED000DW
DESCRIPTION/RESPONSIBILITIES:
Applies analytical and leadership skills to manage workflow, track, and report operational performance for COB Part C/D and Recovery activities. Lead the implementation of new processes and enhancements to improve performance and quality. Execute control validation oversight and analyze data to ensure quality and CMS requirements are met. Utilize strong CMS Medicare Advantage, Prescription Drug, and MSP (Medicare Secondary Payer) knowledge to train, coach, and provide feedback on team performance.
Establish and manage workflow. Monitor, track, and report Part C/D COB and Recovery activities. Ensure timeliness is met and expected outcomes achieved. Lead the implementation of new processes and policy requirements. Lead the identification of process improvement opportunities.
Identify barriers and lead the development of solutions. Support control validation oversight and analyze data to ensure quality and maintain compliance with CMS requirements and BCBSM MA policies. Support vendor oversight and operations for contracted services.
Train, coach, and mentor team members. Provide feedback on team performance. Perform data reconciliation. Research and resolve complex inquiries. Execute department functions as needed. Serve as a subject matter expert regarding CMS and BCBSM MA policies related to COB and Recovery. Represent the department on cross departmental work groups and committees. Assist leadership in analyzing data and reporting findings. Other duties may be assigned.
All qualified applicants will receive consideration for employment without regard to, among other grounds, race, color, religion, sex, national origin, sexual orientation, age, protected veteran status or status as an individual with a disability.
EOE/Minority/Female/Disabled/Veteran
