Hybrid Texas Medicaid Operations Specialist

Health Care Service Corp.; Richardson (TX); Hybrid; USD 85,000 - 120,000; Full time

Job summary

Health Care Service Corporation is seeking an experienced operations professional to support Texas Medicaid managed care functions, including Utilization Management, Care Management, reporting, and compliance. You will coordinate across teams to implement policies and system changes that satisfy UMCM and contract requirements.

The role emphasizes data-driven monitoring, performance evaluation, and corrective actions, with a hybrid schedule in Richardson or Austin, TX.

Qualifications

• Must have a Bachelor Degree in Business with 4 years’ experience OR 8 years of experience in health insurance operations.
• Experience in project development, implementation and execution skills.
• Strong verbal and written communication, and ability to represent Medicaid department at meetings.
• Experience interfacing with internal clients and operations personnel.
• Ability to manage multiple projects effectively and work with all levels of stakeholders.
• Interpersonal, organizational and analytical skills; leadership capabilities.

Responsibilities

• Provide operational services, assistance, and program coordination for Medicaid functions (UM/CM, reporting, compliance, billing, claims, enrollment, customer service).
• Resolve complex internal or external operational questions and support testing and implementation of policies and system changes.
• Monitor performance using data and reporting; identify gaps and coordinate corrective actions.

Skills

Project management

Excel

Power BI

Data analysis

Communication

Leadership

Education

Bachelor Degree in Business

Job description

Health Care Service Corporation is seeking an experienced operations professional to support Texas Medicaid managed care functions, including Utilization Management, Care Management, reporting, and compliance. You will coordinate across teams to implement policies and system changes that satisfy UMCM and contract requirements.

The role emphasizes data-driven monitoring, performance evaluation, and corrective actions, with a hybrid schedule in Richardson or Austin, TX.