Position Overview
Reporting to the Vice President of Product, the Product Sepcialist, Materials, ensures operational excellence and regulatory compliance owning the full spectrum of product member materials and across all Product Lines.
Scope of Role & Responsibilities
- Responsible for all member materials and communications under Product department and Product review.
- Ensures timely cadence of required documents allowing needed time for cross-departmental collaboration.
- Establishes efficient processes related to regulatory communications with an expertise on Medicare ANOC, EOC, and annual CMS and Sales materials.
- Responsible for updating Model Contracts for our QHP/EP and Large group Products adhering to State deadlines.
- Collaborate with internal stakeholders and Compliance to ensure all regulatory materials including member handbooks and member/provider communications, are aligned with CMS and State regulations.
- Periodic review of benefits posted on MetroPlus member and provider web pages pertinent to all MetroPlus products.
- Work closely with Marketing, Regulatory and Compliance to support document creation for internal and external product communication materials.
- Establish and manage efficient processes for member material creation, State and CMS approvals, and mailings in compliance with State and CMS timelines.
- Update Medicaid materials with regulatory model language for State submission and approval, prior to use.
- Partners with the Communications Department for feedback and input on required documents
- Works closely with Regulatory department for approval of documents.
- Provide oversight vendor operations as they relate to required mailings with printing vendors adhering to vendor guidelines and requirements.
Required Education, Training & Professional Experience:
- Bachelor’s degree from an accredited college or university in an appropriate discipline required.
- Master’s degree in business, healthcare or public administration strongly preferred.
- Minimum 5 years’ experience at a Health Plan in a product management or compliance role.
- Knowledge of Medicaid and Medicare products and regulatory environment in NYS
- Experience with CMS ANOC and EOC and NYS model contracts.
- Demonstrated ability to develop and enhance processes, policies, procedures.
- Demonstrated ability to identify opportunities for improvement & implement solutions.
Professional Competencies:
- Leadership
- Results-driven
- Business acumen
- Systems orientation
- Process improvement
- Data-driven decision-making
- Customer focus
- Excellent written & verbal communication skills.
- Resourcefulness
- Ability to work effectively in a fast-paced & constantly evolving environment
- Highly collaborative and demonstrating good judgment in seeking consensus & input from multiple stakeholders to drive decision-making.
- Ability to take initiative & think independently
- Demonstrate understanding & acceptance of the MetroPlus Mission, Vision, & Values
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