Company Statement

For the last 80 years, EmblemHealth has been taking care of New York’s heart and soul, its people. Today, health care is more complex than ever. That’s why we’re at the forefront of change. We work alongside our customers to offer access to high-quality, affordable care, help navigate the health care experience, and make good health achievable; because everyone deserves to be taken care of. We deliver on our mission every day by living our values with our colleagues, members, clients and partners. It begins with caring and respecting all those we work with. We believe a culture of diversity and inclusion is vital to serve our unique and diverse customers. We seek for continues improvement and innovation and believe being agile and nimble is our advantage. We bring a strong sense of partnership to every relationship – internally and externally. The EmblemHealth family of companies offers competitive health, welfare, and retirement benefits as well as incentive pay plans and more.

Government Programs Business Analysis Manager

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Manager & Professional
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2005E Requisition #
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Monitor operational performance of Government Programs Product (Medicare and Medicaid) to ensure that each product is performing as expected.  Work with other business areas across the organization to track and manage various Government Program-specific initiatives.  Manage the performance of individual Government Programs products designed to drive membership growth/retention and operating margin, through analysis and problem solving.  Develop appropriate processes are in place to capture sales activities related to retention and medical initiatives for cost savings.  Drive the development of requirements for new processes to support operational effectiveness and efficiency for Medicare and Medicaid.

Responsibilities:
  • Provide analytics and reporting requirements for all business areas across Government Programs, i.e. sales, retention, product management, medical management, and network management.
  • Produce Medicaid and Medicare monthly scorecards.
  • Analyze enrollment and disenrollment to provide leadership with insight into enrollment and disenrollment trends.
  • Manage the operating committees for Medicaid and Medicare.
  • Develop dashboards and prepare analytics for the various leadership committees and reviewers.
  • Analyze performance dashboards and results, identify opportunities and areas for product improvement.
  • Produce benefit level score cards to monitor cost and utilization activity.
  • Produce reports to support miscellaneous outreach activities, i.e. NH, MSP, ESRD, MA Non Payments, and newly created Medicaid Care Management team. 
  • Ensure the integrity and accuracy of data used for reporting across Government Programs. 
  • Responsible for Medicaid regulatory report production and validate accuracy with the Medicaid team and other business owners.
  • Serve as EH Government Programs reporting and analytics subject matter expert. 
  • Mentor and develop staff to facilitate understanding of Government Program financial goals and objectives across the organization.
Qualifications:
  • Bachelor’s Degree required; MBA or equivalent preferred
  • 5-8 years of relevant work experience, including positions of increasing scope and responsibility required
  • 3-5 years of government programs healthcare experience required
  • Experience in using metrics and analytics to quantify goals and results, and in presenting information in usable form required
  • Excellent communication skills (verbal, written, presentation), including the ability to negotiate and persuade, with all levels and types of audiences, both internally and externally required
  • Industry level knowledge of Medicaid and Medicare rules, regulations, and processes preferred
  • Demonstrated ability to effectively execute on multiple competing priority items/tasks/projects required
  • Working knowledge of program management preferred
  • Proficiency in MS Office suite (excel, word, access, power point) and analytics/ programming (SAS, SQL) required

EEOC Statement

We are committed to leveraging the diverse backgrounds, perspectives and experiences of our workforce to create opportunities for our people and our business. We are an equal opportunity/affirmative action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or any other characteristic protected by law.

Sponsorship Statement

Depending on factors such as business unit requirements, the nature of the position, cost and applicable laws and regulations, EmblemHealth may provide work visa sponsorship for certain positions.

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