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Job Title: Sr. Manager, Medicare Member Communications Operations

Company: Catamaran

Location: Schaumburg, IL

This position is accountable for the development and oversight of Catamaran’s Medicare Member Communications Operations function. The incumbent will utilize knowledge of CMS requirements, industry intelligence, client requirements, sound operational principles, vendor relations, along with excellent project management skills, and to ensure Catamaran’s member communications are compliant, reliable, and consistent with client expectations. The individual in this position shall ensure that appropriate audit and control points are identified and monitored in the operation for each process/correspondence type in a fashion that ensures compliance and identifies opportunities for continual improvement.

This position requires extensive knowledge and experience in interpreting CMS requirements and regulations for the Medicare Part D program as related to Member Communications. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Job Requirements

  • Drive design, development, and timely approval of Client templates for communications for delegated functions; Partner with Account Teams to ensure timely review and approval.
  • Provide oversight for the daily operation and reconciliation of transition benefit scenarios from detection through communications fulfillment through client reporting for compliance
  • Provide oversight for monthly EOB processing across the book culminating in file delivery to client or fulfillment of EOBs via vendor, inclusive of reporting for compliance
  • Supervise staff and managers in template creation, quality assurance functions, and case review relative to EOB, transition, and any other member communications under purview
  • Partner with Print Member Materials team to ensure efficient and operationally sound processes are in place to promote compliance and client satisfaction.
  • Drive development and automation of quality assurance procedures related to development, production, dissemination, and reporting for required communications. 
  • Partner with Product Management on improving quality and competitiveness of offering.
  • Manage EOB and Transition letter components of annual readiness plan managed across the Medicare business line.
  • Demonstrated leadership and management expertise.
  • Outstanding project management track record.
  • Demonstrated track record in Med D Operations (including member communications) and quality improvement efforts
  • Excellent knowledge of CMS regulations related to Medicare member communications
  • Demonstrated ability to work collaboratively in a team environment.
  • Excellent interpersonal and problem-solving skills.
  • Strong customer service orientation and commitment to professionalism.
  • Ability to focus on detail and to demand exquisite attention to detail from others.


Education and Experience:

  • Bachelor’s degree in a business or IT field preferred
  • Five plus years of PBM or Health Plan Operations experience required.
  • Five plus years of progressive management experience required, inclusive of  multiple functions
  • Three plus years experience in Medicare Operations (preference for member communications operations).
  • Strong background in PBM and/or Medicare Part D plan operations preferred.
  • Print vendor interface experience preferred

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