Position Summary:
Responsible for leading, researching, designing, developing, and recommending a strategic plan/program(s) to ensure the organization's "readiness to launch" a comprehensive and competitive response to government program initiatives including Medicaid, Medicare Advantage, and the (State) Children's Health Insurance Programs (CHIP).
Essential Duties:
- Works with the executive team to formulate a business plan and strategy to implement government program capabilities for Delta Dental of Rhode Island and Altus Dental,
- Ensures all current state of readiness gaps in processing capabilities, staffing, and compliance are identified and sufficiently addressed prior to launch,
- Researches and specifies all federal and state regulatory reporting requirements and ensures reports are accurate and delivered within specified timeframes,
- Monitors all contractual specifications and ensures compliance,
- Prepares accurate reports for leadership review and ensures submission within specified timeframes,
- Works with the executive and sales teams to develop partnership strategies and identify opportunities and areas of concern with each relationship,
- Represents the company on relevant association and government related committees such as DDPA, MSDA, and others,
- Creates initial and ongoing landscape threat analysis,
- Monitors competitors and identifies potential collaborators,
- Assesses both commercial and government retiree market potential and strategy to address this population,
- Analyzes and summarizes relevant research in clear and concise formats with accompanying recommendations,
- Initiates external contacts required to foster collaboration and partnerships; Develops and delivers professional presentations to internal and external stakeholders,
- Serves as the organization's internal subject matter expert in government programs and stays abreast of new requirements and developments in the this space; Works with the executive team and external firms to continuously monitor legislative and regulatory activity and provide summarized analysis of research performed,
- Works with the Professional Relations team(s) on development of proper contracting and credentialing procedures.
Qualifications:
- 4-year degree in relevant field of study
- 10 or more year's experience in the insurance sector
- 5 or more years leading government programs in the insurance sector
- Solid knowledge of insurance principles
- Proven tract record of strategic, multi-disciplinary thinking