VP, Medicare Strategy & Operations
Job Description
We take great strides to ensure our employees have the resources to live well, be healthy, continue learning, develop skills, grow professionally and serve our local communities. We invite you to apply for a career with us.
Residency in or relocation to Louisiana is preferred for all positions.
Position Purpose
Provide executive leadership for the Medicare Advantage (MA) program, owning end-to-end performance across strategy, operations, and financial outcomes. This role drives results across product design, regulatory compliance, quality (Stars), risk adjustment, and member experience, while partnering across a highly matrixed organization to achieve enterprise goals.
How You Contribute to the Company’s Mission in this Role
Own the full lifecycle performance (P&L) of the Medicare Advantage business, ensuring financial sustainability and market competitiveness.
Develop and execute MA strategy, including product design, benefit structure, and market positioning aligned to enterprise priorities.
Drive performance across key metrics including Star Ratings, risk adjustment, HEDIS®, member satisfaction, and retention.
Lead cross-functional execution across shared services (e.g., claims, medical management, network, finance, IT) through influence and governance structures.
Ensure compliance with CMS, state, and BCBSA requirements, proactively adapting to regulatory changes.
Establish and monitor operational dashboards; identify risks and implement corrective actions to achieve performance targets.
Partner with analytics, quality, and risk adjustment leaders to define and execute improvement strategies.
Support bid development and annual planning processes to align financial, operational, and market objectives.
Provide executive-level reporting and insights to senior leadership and the Board.
Build and lead high-performing teams, fostering a culture of accountability, continuous improvement, and service excellence.
Required Qualifications
Bachelor’s degree in Business, Healthcare Administration, or related field required
10+ years of progressive experience in healthcare or health insurance
5+ years in health plan operational leadership
Significant experience in Medicare Advantage required
Experience in MA product strategy, operations, Star Ratings, quality, and/or risk adjustment
Demonstrated success leading large, cross-functional initiatives in a matrixed environment
Deep knowledge of Medicare Advantage operations, regulatory requirements, and market dynamics
Proven ability to drive performance across financial, quality, and operational metrics
Strong strategic thinking and analytical capabilities
Executive presence with the ability to communicate effectively with senior leadership and the Board
Ability to influence without direct authority across matrixed teams
Experience leading complex programs, systems, or large-scale initiatives
Strong relationship-building and stakeholder management skills
Preferred Qualifications
Master’s degree (MBA, MPH, or equivalent) preferred
Relevant experience may substitute for education
PMP or similar certification preferred
The physical demands described here are representative of those that must be met to successfully perform this role. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.
- Work is performed in a standard office environment with normal noise levels
- Work is primarily sedentary (sitting or standing)
- Requires the ability to analyze, interpret, and present complex information
An Equal Opportunity Employer
All internal employees please apply through Workday Careers.
PLEASE USE A WEB BROWSER OTHER THAN INTERNET EXPLORER IF YOU ENCOUNTER ISSUES (CHROME, FIREFOX, SAFARI)
Additional Information
Please be sure to monitor your email frequently for communications you may receive during the recruiting process. Due to the high volume of applications we receive, only those most qualified will be contacted. To monitor the status of your application, please visit the "My Applications" section in the Candidate Home section of your Workday account.
If you are an individual with a disability and require a reasonable accommodation to complete an application, please contact [email protected] for assistance.
In support of our mission to improve the health and lives of Louisianians, we encourage the good health of its employees and visitors. We want to ensure that our employees have a work environment that will optimize personal health and well-being. Due to the acknowledged hazards from exposure to environmental tobacco smoke, and in order to promote good health, our company properties are smoke and tobacco free.
We perform background and pre-employment drug screening after an offer has been extended and prior to hire for all positions. As part of this process records may be verified and information checked with agencies including but not limited to the Social Security Administration, criminal courts, federal, state, and county repositories of criminal records, Department of Motor Vehicles and credit bureaus. Pursuant with sec 1033 of the Violent Crime Control and Law Enforcement Act of 1994, individuals who have been convicted of a felony crime involving dishonesty or breach of trust are prohibited from working in the insurance industry unless they obtain written consent from their state insurance commissioner.
Additionally, we are a Drug Free Workplace. A pre-employment drug screen will be required and any offer is contingent upon satisfactory drug testing results.