Ohio Medicaid Claims Program Manager (Hybrid)

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

Benefits offered by this job

Hybrid work schedule

Vaccination policy

Job summary

Elevance Health in Ohio is seeking a Program Manager for the Ohio MyCare program. The role focuses on Medicaid claims configuration, rate changes, compliance and contractual updates, and supports external client‑facing initiatives.

You will collaborate with claims teams, provider experience, utilization management, regulatory and call center leads to resolve issues and ensure on-time regulatory reporting, oversee end‑to‑end claims processing, and serve as the liaison with the State of Ohio and

Qualifications

• Requires a BA/BS and minimum of 5 years external client facing experience in program/project management.
• Equivalent combination of education and experience may be considered.

Responsibilities

• Collaborate with claims teams, provider experience, utilization management, regulatory and call center leads to resolve issues related to claims policies and provider payments.
• Ensure on-time delivery of regulatory reports related to claims (e.g. Prompt Pay, Claims Disputes).
• Develop, approve, implement and ensure compliance of external client facing programs.
• Research industry trends and best practices in claims management.
• Manage external client facing relationships with corporate and regional teams.
• Oversee end-to-end claims process including adjudication, payment and reporting.
• Serve as the operational liaison with the state of Ohio and internal leadership.

Skills

Program management

External client facing

Regulatory reporting

Medicare/Medicaid

Education

BA/BS degree

Graduate degree preferred

Job description

Elevance Health in Ohio is seeking a Program Manager for the Ohio MyCare program. The role focuses on Medicaid claims configuration, rate changes, compliance and contractual updates, and supports external client‑facing initiatives.

You will collaborate with claims teams, provider experience, utilization management, regulatory and call center leads to resolve issues and ensure on-time regulatory reporting, oversee end‑to‑end claims processing, and serve as the liaison with the State of Ohio and