Sign upLog in

VP, Medicare Strategy & Operations

Blue Cross and Blue Shield of Louisiana

Baton Rouge, LA

Apply
JOB DETAILS
SKILLS
Analysis Skills, Business Administration, Channel Strategies, Claims Management, Communication Skills, Content Management Systems (CMS), Continuous Improvement, Corrective Action, Cross-Functional, Customer Experience, Finance, Financial Operations, Health Insurance, Health Plan, Healthcare Administration, Healthcare Effectiveness Data and Information Set (HEDIS), Insurance, Large-Scale Systems, Law Enforcement, Leadership, Maintain Compliance, Matrix Management, Medicare, Operations Planning, Performance Metrics, Physical Demands, Product Design, Product Strategy, Profit & Loss, Project Management Professional (PMP), Quality Metrics, Regulations, Regulatory Compliance, Regulatory Requirements, Reporting Dashboards, Risk, Risk Analysis, Social Security Administration, Strategic Analysis, Sustainability
LOCATION
Baton Rouge, LA
POSTED
7 days ago
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 recruiting@bcbsla.com 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._


JOB CATEGORY:Insurance

About the Company

B

Blue Cross and Blue Shield of Louisiana