Position Summary...

What you'll do...

About Walmart Claims Services

Walmart Claims Services administers casualty claims for Walmart Inc., its subsidiaries and affiliates, and Walmart’s insurance carriers. This includes adjusting customer and associate claims on behalf of Walmart, Sam’s Club, and Supply Chain. The Manager, Medicare Program Oversight and Optimization, is responsible for supporting Medicare regulatory program for Walmart Claims Services. This position manages MSP processes where Walmart is a Medicare Secondary Payer.

What you'll do:

Program oversight is critical for success. This role analyzes the overall Medicare program and its processes to ensure our business is operating in a best-in-class manner while adhering to Medicare’s expectations. This role is also responsible for the education of the organization and leads change management. Below is specific execution that drives program success.

In this role, you’ll be responsible for…

Medicare Program

• Section 111 reporting requires vigilant management, well trained associates, and several reports to identify areas of opportunity. This role should carefully review claim data to ensure that all reportable claims are timely updated in advance of the key quarterly claim input file dates. Corrections must be made while building toward the end of the quarterly reporting cycles.
• Lead change management efforts and influences Walmart Claims Services to align with requirements; Analyze data to identify insights; Facilitate corrective action process.
  • Analyze reports from TPRA vendor and claims system to identify insights. Then collaborate with TPRA vendor, claims teams or systems team to facilitate improvement/efficiencies.
  • Insights identified through data analysis will be used to identify overall performance gaps in the program or associate behavior while following the oversight management process.
  • This role will leverage program insights to identify knowledge gaps and develop educational materials and events.
  • Regulatory legislation developments / legal findings that require organizational change to mitigate.
  • Analyzes Medicare Regulations and evaluates & implements internal processes to ensure compliance with Medicare to include accurate reporting under Section 111. Stives to eliminate lien referrals to the US Department of Treasury.
  • Collaborates TPRA vendor and legal counsel on changes in federal regulations and state statutes that impact risk and implements action plans to ensure compliance. Includes the prevention of penalties and interest related to reporting requirements or timeliness of payments.
  • Collaborates with internal partners and TPRA vendor to develop and implement internal Medicare educational program for the organization.
  • Demonstrates up-to-date expertise and applies this to the development, execution, and improvement of action plans by providing expert advice and guidance to others in the application of information and best practices; supporting and aligning efforts to meet customer and business needs; and building commitment for perspectives and rationales.
  • Provides and supports the implementation of business solutions by building relationships and partnerships with key stakeholders; identifying business needs; determining and carrying out necessary processes and practices; monitoring progress and results; recognizing and capitalizing on improvement opportunities; and adapting to competing demands, organizational changes, and new responsibilities.
  • Models compliance with company policies and procedures and supports company mission, values, and standards of ethics and integrity by incorporating these into the development and implementation of business plans; using the Open Door Policy; and demonstrating and assisting others with how to apply these in executing business processes and practices.

What you'll bring:

• Ability to identify compliance concerns and business insights by collecting necessary data and analyze; identify trends and insights; communicates findings to leaders and recommends/ implements solutions to concerns.
• Ability to make decisions and exercise sound judgement concerning complex needs - engagement with Insurers, Legal and Regulatory entities to ensure alignment of requirements; recommends/ implements solutions to concerns.
• Ability to monitor and identify regulatory legislation developments that require organizational change to mitigate risks.
• Ability to leverage resources and use judgement to define policies.

About Walmart

Flexible, hybrid work:
We use a hybrid way of working that is primarily in office coupled with virtual when not onsite. Our campuses serve as a hub to enhance collaboration, bring us together for purpose and deliver on business needs. This approach helps us make quicker decisions, remove location barriers across our team and be more flexible in our personal lives.

Benefits:
Benefits: Beyond our great compensation package, you can receive incentive awards for your performance. Other great perks include 401(k) match, stock purchase plan, paid maternity and parental leave, PTO, multiple health plans, and much more.

Equal Opportunity Employer:
Walmart, Inc. is an Equal Opportunity Employer – By Choice. We believe we are best equipped to help our associates, customers and the communities we serve live better when we really know them. That means understanding, respecting and valuing diversity- unique styles, experiences, identities, ideas and opinions – while being inclusive of all people.

The above information has been designed to indicate the general nature and level of work performed in the role. It is not designed to contain or be interpreted as a comprehensive inventory of all responsibilities and qualifications required of employees assigned to this job. The full Job Description can be made available as part of the hiring process.

Preferred Qualifications...

• Strong, succinct written and verbal communication skills.
• Ability to work at pace, effectively under pressure, drive projects to completion on time.
• Flexibility and the ability to adapt quickly to change.
• Change Management
• Leading a cross-functional team
• Supervisory

You’ll sweep us off our feet if you have…

• Bachelor’s degree in business.
• Experience with advanced functionality of Microsoft Office
• Four+ years’ experience in Medicare compliance within a corporate environment.
• Experience working in a regulatory compliance business environment.

Primary Location…

608 SW 8TH ST, BENTONVILLE, AR 72712-6207, United States of America

Minimum Qualifications

• Bachelor's degree in Business, Arts, Science, or related field and 1 year experience in insurance claims, law or related field OR 6 years of experience in insurance claims, law or related field.
• Medicare experience in the field of insurance claims management

Preferred Qualifications

• Master's in Business Administration (MBA)or Master's in related field.
• Juris Doctorate(JD).
• 1 year experience working in a legal or compliance-related environment.
• Experience with State or Federal agencies, such as CMS, HHS, etc.)
• Certified Medicare Secondary Payer Professional (CMSP) designation or similar certification
• Insurance adjuster license.

Minimum Qualifications...

Outlined below are the required minimum qualifications for this position. If none are listed, there are no minimum qualifications.

Option 1: Bachelor's degree in business, human resources, information technology, or related area and 1 year's experience in business, human resources, information technology, or related area.

Option 2: 3 years’ experience in business, human resources, information technology, or related area.
2 years' supervisory experience.

Preferred Qualifications...

Outlined below are the optional preferred qualifications for this position. If none are listed, there are no preferred qualifications.

Bachelor's degree in business, human resources, information technology, or related area, experience in business, human resources, information technology, or related area., Using advanced functionality of Microsoft Office

Primary Location...

608 SW 8TH ST, BENTONVILLE, AR 72712-6207, United States of America