Hybrid Ohio Medicaid Claims Program Manager

Elevance Health (Anthem); Columbus (OH); Hybrid; USD 93,000 - 139,000; Full time

Benefits offered by this job

Comprehensive benefits package

Equity stock purchase plan

401(k) contribution

Job summary

Elevance Health in Columbus, OH seeks a Program Manager for Ohio Medicaid claims. Role requires Ohio residence with in-office 1–2 days weekly, enabling collaboration while maintaining flexibility.

The PM will manage Ohio Claims, ensure resolution of configuration issues, rate changes, compliance and contractual updates. Prior PM experience with external client facing programs is valued.

Qualifications

• Requires a BA/BS and at least 5 years external client facing PM experience.
• Experience with regulatory reporting development and submission.
• Strong understanding of dual Medicare and Medicaid claims configuration.

Responsibilities

• Collaborate with claims, provider experience, utilization management, regulatory and call center leads to resolve claims policy issues.
• Ensure on-time delivery of regulatory claims reports (e.g., Prompt Pay, Claims Disputes).
• Coordinate development, approval, implementation and compliance of external client facing programs.
• Research industry practices to stay aware of trends affecting claims programs.
• Manage external client relationships and partner with corporate and regional teams.
• Develop program success measures and perform periodic assessments.
• Oversee end-to-end claims process: receipt, adjudication, payment, reporting.
• Serve as liaison with the state of Ohio, Provider Experience, and leadership.

Skills

Program management

External client facing experience

Regulatory reporting

Education

BA/BS degree

Graduate degree preferred

Job description

Elevance Health in Columbus, OH seeks a Program Manager for Ohio Medicaid claims. Role requires Ohio residence with in-office 1–2 days weekly, enabling collaboration while maintaining flexibility.

The PM will manage Ohio Claims, ensure resolution of configuration issues, rate changes, compliance and contractual updates. Prior PM experience with external client facing programs is valued.