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Sr Medicare Regulatory Analyst - WFH

Health Care Service Corporation

Role overview

Qualifications

  • Bachelor Degree in Business OR 3 years experience with health insurance
  • 2 years experience with health insurance benefits and/or operations
  • Knowledge of Medicare Part D product
  • Verbal and written communication skills

Responsibilities

  • Investigate and resolve high-profile Medicare Part D complaints and grievances
  • Ensure CMS regulatory compliance
  • Support audit activities
  • Manage drug recall communications

Key facts

Hard skills

Medicare Part D Query Planning Insurance Sales Online Communication Pharmacy Operations Presentation Training

Other skills

  • Non-Verbal Communication
  • Microsoft Word
  • Microsoft Excel
  • Microsoft PowerPoint
  • Microsoft Outlook
  • Organizational Skills

About the company

Health Care Service Corporation logo

Health Care Service Corporation

Health Insurance (Payers)

Health Care Service Corporation, a Mutual Legal Reserve Company (HCSC), is an Independent Licensee of the Blue Cross and Blue Shield Association. We are the largest customer-owned health insurer in the United States, serving more than 18.6 million members through our Plans in Illinois, Montana, New Mexico, Oklahoma, and Texas. For nearly a century, we have enabled and coordinated the access to quality care for millions of members. Our experience and industry knowledge establishes a solid foundation for our future—driving innovations that further expand access, improve health outcomes, and reduce costs. Embedded within the fabric of how we operate is a deep sense of caring and commitment that informs how we serve our members, engage in local communities, and deliver positive change to the health care industry. As health care needs evolve, we leverage our portfolio of companies to deliver differentiated value to all industry stakeholders so that, together, we make more possible. Join HCSC and discover what new ways of thinking can mean for you, your community, our customers and our organization: HCSC.com/careers. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to an inclusive, drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, national origin, disability, or protected veteran status.

Company details

Company typeXLarge
IndustryHealth Insurance (Payers)
Company size10001

Links

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Job description

At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.

Join HCSC and be part of a purpose-driven company that will invest in your professional development.

Job Summary

Basic Function:
Responsible for investigating and resolving high-profile Medicare Part D complaints and grievances, ensuring CMS regulatory compliance, supporting audit activities, managing drug recall communications, coordinating emergency access-to-benefits processes, and partnering across departments to implement operational and system improvements.

Required Job Qualifications:
*Bachelor Degree in Business OR 3 years experience with health insurance.
*2 years experience with health insurance benefits and/or operations.
*Knowledge of Medicare Part D product
*Verbal and written communication skills.
*Ability to present Medicare trends and findings in meetings with management.
*Ability to organize multiple tasks and responsibilities.
*Ability to analyze data reports.
*Experience developing and running queries in a database.
*PC proficiency to include Microsoft Word, Excel, PowerPoint and Outlook

Preferred Job Qualifications:

*Knowledge of CMS software application MARx.

*Prescription Drug coverage and knowledge of CMS Part D Regulations and Guidelines.

*Knowledge of Prescription Drug benefits as well as Retail or other Pharmacy operations

Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!

Pay Transparency Statement:

At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees.  Learn more about our benefit offerings by visiting https://careers.hcsc.com/totalrewards.

The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan.

HCSC Employment Statement:

We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.

Base Pay Range

$55,900.00 - $123,500.00

Exact compensation may vary based on skills, experience, and location.

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Marcus Rivera

Chief Revenue Officer

m.rivera@company.com
linkedin.com/in/marcusrivera
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