• Own MA operational performance, including planning, budgeting, KPIs, SOPs, and team capability development.

• Ensure compliant, high-integrity claims and payment operations, including FDR oversight, payment integrity, and fraud, waste, and abuse controls.

• Lead business requirements, system implementations, UAT, and change management in partnership with the FEP Operations Center and cross-functional stakeholders.

• Apply deep Medicare Advantage regulatory and operational expertise to ensure CMS compliance, audit readiness, Star Ratings performance, and quality improvement.

• Drive strategic planning, multi-year operational roadmaps, and process optimization using Lean Six Sigma and industry benchmarking.

• Manage vendor relationships, contracts, and RFPs; represent MA operations in governance forums and with CMS.

• Support enrollment, member services, provider network operations, ANOC/EOC planning, and member experience initiatives.

• Serve as a senior liaison and communicator, presenting recommendations to leadership and mentoring operational staff.

The posted salary range is the lowest to highest salary we, in good faith, believe we would pay for this role at the time of this posting.  We may ultimately pay more or less than the hiring range and this hiring range may also be modified in the future. A candidate’s position within the hiring range may be based on several factors including, but not limited to, specific competencies, relevant education, qualifications, certifications, relevant experience, skills, seniority, performance, shift, travel requirements, and business or organizational needs. This job is also eligible for annual bonus incentive pay. 

We offer a comprehensive package of benefits including paid time off, 11 holidays, medical/dental/vision insurance, generous 401(k) matching, lifestyle spending account and many other benefits to eligible employees. 

Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.