MetroPlus Health provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health Hospitals, the largest public health system in the United States, MetroPlus Health network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlus has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.

Position Overview

The Product Specialist, Medicare is a critical role in support of the efficient functioning of the Medicare product team. The Product Specialist, Medicare will perform complex and diverse duties, assist in problem solving, program/project planning, development, and execution of stated goals and objectives.

• Work with Product leads on product, enrollment and benefit implementations, aligning the organizational strategy of products.
• Participate in key strategic and operational meetings both internally and externally.
• Assist with Part C and D annual data validation submissions.
• Be a liaison between MetroPlusHealth and vendors that manage enrollment and claims.
• Be well-versed in, or willing to learn, federal and state regulations and policies relevant to the health insurance industry.
• Assist in benefit grids, ensuring updates are made accurately and timely.
• Understand multiple product line processes, working to streamline processes across all products.
• Work as project manager within product team, ensuring projects are on track and timely.
• Assist in the coordination, supervision, and completion of special projects as appropriate.
• Assist multiple members of the team in developing policies & procedures, workflows, and KPI dashboards/reports, preparing materials for presentations, maintaining workplans & meeting agendas.
• All other tasks as assigned or needed.

• Associate's degree from an accredited college or university in business, the sciences, humanities, public health/policy required.
• Three years of prior experience in a Managed Care setting.
• Two years of CMS and Medicare experience preferred.
• Demonstrated ability to develop workflows, policies, procedures.
• Demonstrated ability to identify opportunities for improvement & implement solutions.

Professional Competencies

• Results-driven
• Systems orientation
• Process improvement
• Data-driven
• Customer focus
• Resourcefulness
• Ability to work effectively in a fast-paced & constantly evolving field
• Excellent written & verbal communication skills.
• Excellent analytical skills demonstrated by an ability to use actionable data to support decision-making.
• Demonstrate understanding & acceptance of the MetroPlus Mission, Vision, & Values

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