Company Statement
ConnectiCare is a leading health plan in the state of Connecticut. ConnectiCare’s mission is to make it easy for members to get the care they need. A local company for over 35 years, ConnectiCare has a full range of products and services for businesses, municipalities, individuals and those who are Medicare-eligible. A subsidiary of EmblemHealth, ConnectiCare leads the individual and small group markets in the state, and is ranked among the top commercial health plans in the nation, according to the National Committee for Quality Assurance.
We’re looking for individuals who want to make a difference in the communities we serve. If you want to join a local team and help change the way health care is delivered, ConnectiCare is the place for you.
Medicare Product Specialist
Job Summary: The Medicare Product Specialist will support Medicare Product development, management and implementation initiatives to ensure product line outcomes are achieved while maintaining regulatory requirements.
Responsibilities:
• Serve as subject matter expert on the Medicare product portfolio. Develop and maintain an in-depth knowledge of CMS regulations, guidelines and timelines related to benefits.
• Develop the Annual Notice of Change and Evidence of Coverage documents in accordance with CMS regulations. Work with internal and external partners to ensure regulatory compliance on document contents and distribution.
• Coordinate annual review of employer group plans designs; including recommendation of benefit changes (both compliance and business driven) and updating all documentation.
• Monitor marketplace for information on competitive activities as it relates to product offerings. Develop and maintain detailed information on competitor plan designs.
• Accountable for the development of the Summary of Benefit and Cost Sharing Guide documents.
• Maintain plan design documentation for internal and external partners.
• Review CMS websites for accuracy of plan information related to benefits and cost sharing.
• Develop and maintain department policies and procedures.
• Research and respond to benefit related complaints and inquiries as needed.
• Actively participate as the Medicare Product representative in assigned committees, projects and meetings.
• Assist in the review of all organization materials as they relate to benefits and cost sharing.
• Develop and deliver product training as necessary.
• Some (New York and Connecticut) travel may be required.
• Performs other related projects and duties as assigned.
Qualifications:
• Bachelor’s Degree or an equivalent combination of education and experience
• At least 3 years of managed care experience with an emphasis on product management
• Experience in Medicare required; experience in Medicare Advantage strongly preferred
• Proven ability to work with cross functional teams
• Excellent written and oral communication skills and a demonstrated ability to interpret government regulations
• Excellent problem solving skills and ability to manage multiple priorities
• Excellent organization skills with a demonstrated ability to set priorities and follow-through
• Proven ability in utilizing Windows PC software applications
Essential Job Functions:
• Primarily sedentary
• Must be able to use standard office equipment
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.