Medical Operations Program Assistant II

Sdsoybean; Sioux Falls (SD); On-site; USD 32,000 - 41,000; Full time

Job summary

The Department of Social Services / Medical Services in Pierre, SD or Sioux Falls, SD seeks an Operations Program Assistant II to support the Medicaid program. You will assist with data entry, provider inquiries, and claims processing while ensuring timely, accurate resolution of issues.

Qualified candidates will have data entry or claims experience, knowledge of Medicaid or healthcare billing is a plus, and strong communication skills to liaise with providers and internal teams.

Qualifications

• Experience in data entry, claims processing or customer service.
• Knowledge of Medicaid, healthcare billing or medical claims preferred.
• Ability to interpret policies and determine claim outcomes.
• Strong written and verbal communication with internal and external stakeholders.

Responsibilities

• Determine appropriateness of requests to reprocess claims and approve/deny reconsiderations.
• Monitor inquiries via the provider portal and DSS email system.
• Assist training on claim entry into the Portal and route advanced queries.
• Compile and report data entry errors and communicate recurring issues for training.
• Monitor daily claims and workflow to ensure timely processing.

Skills

Data entry

Claims processing

Customer service

Provider portal navigation

Communication

Team coordination

Tools

Medicaid Online Portal

Provider portal

Data management tools

Job description

Medical Operations Program Assistant II - 38212

23.56 - 29.44 US per hour

Posted 3 days ago | Apply before November 10, 2026

Description

Job ID: 38212
Agency: Department of Social Services / Medical Services
Location:Pierre, SD or Sioux Falls, SDSalary:$23.56-$29.44 Hourly, depending on qualifications
Pay Grade:H
Closing Date: 11.10.2026

This is a Full-Time 40 Hours Weekly position with the Department of Social Services. For more information on the DSS, please visit https://dss.sd.gov .

Summary:

The Division of Medical Services is seeking a highly motivated individual to serve as an Operations Program Assistant II for the South Dakota Medicaid Program. This position is responsible for providing high-quality customer service to South Dakota Medicaid providers and will serve as a key resource in the day-to-day operations of the Medicaid Data Entry team.

Responsibilities include determining appropriateness of requests to reprocess claims, and approving or denying provider claim reconsideration requests made through the Medicaid Online Portal. This position will also monitor and respond to inquiries received through the provider portal and DSS email system, support training on claim entry into the Portal, and as needed, direct advanced inquiries to the appropriate personnel. This position is also responsible for compiling and reporting data entry errors and communicating recurring issues to the Operations Manager and CAPS Supervisor to support appropriate staff training. Additional duties include monitoring daily claims received and the workflow to ensure the claims are processed in a timely fashion.

This position will assist with processing complex claims and may provide other support, as assigned, to the claims processing and data entry teams as needed.

The Ideal Candidate Will Have:

Candidates should have experience in data entry, claims processing, or customer service. Experience with Medicaid, healthcare billing or medical claims preferred but not necessary.

Knowledge, Skills, and Abilities of:

• use written words and skillful verbal communications;
• accurately interpret and apply policies to determine appropriate outcomes of claim reconsiderations;
• establish, build, and maintain cooperative and productive internal and external relationships; demonstrate compassion, respect, courtesy, and tact in all interactions;
• gather and analyze data to identify problems and potential issues, and develop and implement appropriate resolutions;
• communicate information clearly and concisely, both verbally and in writing, while keeping all appropriate parties informed;
• adapt effectively to changing policies and procedures;
• manage multiple tasks simultaneously while maintaining accuracy and meeting deadlines;
• navigate provider portals, email systems, and data management tools with confidence;
• work independently while also providing support to team members.

This position is eligible for Veterans’ Preference per ARSD 55:10:02:08.

The State of South Dakota does not sponsor work visas for new or existing employees. All persons hired will be required to verify identity and eligibility to work in the United States and complete an Employment Eligibility Verification, Form I-9.The State of South Dakota as an employer will be using E-Verify to complete employment eligibility verification upon hire.

The State of South Dakota offers $0 premium employee health insurance option plus eleven paid holidays, generous vacation and sick leave accrual, dental, vision, and other insurance options, and retirement benefits. You can view our benefits information here .This position is a member of Class A retirement under SDRS.