Director, Medicare & Medicaid Claims Operations

Elevance Health; Tampa (FL); Hybrid; USD 140,000 - 190,000; Full time

Job summary

Elevance Health in Tampa, FL seeks a Director of Government Claims Operations to lead end-to-end Medicare and Medicaid first-time and post-pay claims, inquiries, and adjustments. You will drive regulatory compliance, audit readiness, and performance improvements in a large, complex operation.

The role emphasizes automation initiatives, cross-functional leadership, and robust controls, with in-office three days per week and hybrid flexibility to support collaboration and productivity.

Qualifications

• Requires a BA/BS and 7 years leadership experience.
• Experience leading health plan claims operations for Medicare and Medicaid.
• Experience guiding claims automation initiatives and operational readiness.
• Executive-level communication and cross-functional influence skills.

Responsibilities

• Oversee end-to-end government claims: first-time, post-pay, and adjustments.
• Ensure SLAs, prompt-pay, quality standards and regulatory compliance.
• Lead, train, and evaluate performance of staff.
• Partner with technology, analytics, finance, compliance and vendor teams to drive integrated solutions.

Skills

Leadership experience

Executive communication

Cross-functional collaboration

Education

BA/BS degree

Job description

Elevance Health in Tampa, FL seeks a Director of Government Claims Operations to lead end-to-end Medicare and Medicaid first-time and post-pay claims, inquiries, and adjustments. You will drive regulatory compliance, audit readiness, and performance improvements in a large, complex operation.

The role emphasizes automation initiatives, cross-functional leadership, and robust controls, with in-office three days per week and hybrid flexibility to support collaboration and productivity.