Senior Manager, Customer Care & Medicare Strategy – Leading Patient Advocacy & Appeals Optimization at brighthush

About brighthush

brighthush is a forward‑thinking, mission‑driven health plan that is reshaping the way Medicare beneficiaries experience care. With a commitment to transparency, compassion, and innovation, we empower our members, providers, and stakeholders to achieve better health outcomes and a brighter future. Our culture is built on collaboration, continuous learning, and a deep respect for the unique stories of every individual we serve.

Position Overview

As the Senior Manager, Customer Care & Medicare Strategy, you will be the linchpin of our Medicare grievance and appeals operations. You will lead a high‑performing team of customer care specialists, drive process improvements, and translate data insights into actionable strategies that elevate member satisfaction and operational efficiency. This role is ideal for a seasoned leader who thrives in a fast‑paced, data‑driven environment and is passionate about making a tangible difference in the lives of Medicare beneficiaries.

Key Responsibilities

• Team Leadership & Development – Recruit, coach, and mentor a diverse team of grievance and appeals specialists, fostering a culture of accountability, continuous improvement, and professional growth.
• Process Oversight & Optimization – Design, implement, and refine end‑to‑end grievance and appeals workflows, ensuring compliance with CMS regulations and internal quality standards.
• Data‑Driven Decision Making – Analyze operational metrics, identify trends, and develop dashboards that provide real‑time visibility into team performance, member satisfaction, and cost drivers.
• Stakeholder Collaboration – Partner with cross‑functional teams (e.g., Claims, Compliance, IT, and Member Experience) to align strategies, resolve escalated issues, and champion member‑centric solutions.
• Quality & Compliance Assurance – Monitor adherence to regulatory requirements, internal policies, and industry best practices; lead root‑cause analyses and corrective action plans.
• Strategic Planning & Execution – Contribute to the development of the Medicare strategy roadmap, setting quarterly goals, and translating them into executable action plans.
• Technology & Tool Management – Oversee the utilization of ACD systems, call management platforms, and Microsoft Office Suite to streamline operations and enhance data integrity.
• Continuous Improvement Initiatives – Champion Lean Six Sigma projects, process mapping, and automation opportunities that reduce cycle time and improve member outcomes.

Essential Qualifications

• Bachelor’s degree in Business Administration, Healthcare Management, or a related field (or equivalent experience).
• Minimum of 3 years of progressive management experience in a customer service or claims environment.
• At least 4 years of hands‑on experience managing Medicare grievance and appeals processes.
• Strong knowledge of CMS regulations, Medicare policies, and industry standards.
• Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint, Outlook) and experience with ACD and call management systems.
• Demonstrated ability to analyze complex data sets, develop actionable insights, and present findings to senior leadership.
• Excellent communication, negotiation, and conflict‑resolution skills.
• Proven track record of leading high‑performing teams and driving continuous improvement.

Preferred Qualifications

• Advanced degree (MBA, MPH, or related) or relevant certifications (e.g., Six Sigma Green Belt, Certified Customer Experience Professional).
• Experience with CRM platforms (Salesforce, Zendesk) and data visualization tools (Power BI, Tableau).
• Background in healthcare operations, claims processing, or member experience roles.
• Familiarity with agile project management methodologies.
• Experience managing remote or hybrid teams across multiple time zones.

Core Skills & Competencies

• Strategic Thinking – Ability to translate long‑term goals into short‑term actions.
• Analytical Acumen – Strong quantitative skills and a data‑driven mindset.
• Leadership & Influence – Inspiring others, building consensus, and driving change.
• Customer‑Centric Mindset – Deep empathy for Medicare beneficiaries and a commitment to improving their experience.
• Process Optimization – Expertise in Lean, Six Sigma, or similar methodologies.
• Technology Savvy – Comfortable adopting new tools and platforms to enhance efficiency.
• Communication Excellence – Clear, concise, and persuasive communication across all levels.

Career Growth & Learning Opportunities

At brighthush, we believe that professional development is a shared responsibility. As Senior Manager, you will:

• Participate in leadership development programs that sharpen strategic, financial, and operational skills.
• Engage in cross‑functional projects that broaden your exposure to different facets of the organization.
• Access a curated library of industry research, webinars, and conferences to stay ahead of Medicare policy changes.
• Receive mentorship from senior executives who are passionate about nurturing the next generation of leaders.
• Explore potential career paths into Director or VP roles within Customer Experience, Operations, or Strategy.

Work Environment & Culture at brighthush

Our remote‑first culture empowers you to work from anywhere in Ohio while staying connected through:

• Weekly virtual town halls and team huddles.
• Collaborative tools such as Microsoft Teams, SharePoint, and Slack.
• Flexible scheduling that respects work‑life balance.
• A supportive community that celebrates diversity, equity, and inclusion.
• Regular virtual social events, wellness challenges, and peer‑recognition programs.

Compensation, Perks, and Benefits

We offer a competitive total rewards package that includes:

• Base salary range: $83,000 – $132,800 per year, commensurate with experience.
• Performance‑based bonuses and incentive plans.
• Comprehensive health, dental, and vision insurance.
• 401(k) plan with company match.
• Generous paid time off, including vacation, sick leave, and holidays.
• Professional development stipend and tuition reimbursement.
• Wellness programs, mental health resources, and employee assistance programs.
• Technology stipend for home office setup.

Why Join brighthush?

At brighthush, you will be part of a mission‑driven organization that places member well‑being at the heart of everything we do. You’ll have the opportunity to:

• Lead transformative initiatives that directly improve Medicare beneficiaries’ experience.
• Work alongside passionate professionals who value collaboration, innovation, and integrity.
• Shape the future of Medicare customer care through data‑driven insights and strategic leadership.
• Grow your career in a supportive environment that rewards excellence and encourages continuous learning.

Ready to Make an Impact?

If you are a strategic thinker, data‑savvy leader, and compassionate advocate for Medicare members, we invite you to apply for the Senior Manager, Customer Care & Medicare Strategy role at brighthush. Join us in creating a brighter, healthier future for our members and the communities we serve.