Program Manager II - Medicare/Marketplace Claims

Arizona Complete Health; Illinois; Remote; USD 68,000 - 124,000; Full time

Job summary

A leading health organization seeks a Program Manager II for Medicare and Marketplace Claims. In this role, you will leverage your project management and data analysis skills to enhance program delivery, improve processes, and ensure compliance. With competitive benefits and a flexible work environment, you will address critical health services for millions of members.

Benefits

Health insurance

401K

Tuition reimbursement

Paid time off

Flexible work options

Qualifications

• 3+ years of project management experience.
• Healthcare experience preferred.
• Balance of analytical, project management, and communication skills.

Responsibilities

• Support AZ Complete Health by planning and overseeing programs.
• Ensure Medicare and Marketplace deliverables meet quality standards.
• Drive process improvements and collaborate effectively with cross-functional teams.

Skills

Data analysis

Project management

Healthcare operations

Cross-functional collaboration

Process improvement

Education

Bachelor's degree in a related field

Tools

Microsoft Project

Smartsheet

SQL

Microsoft Office Suite

Microsoft Teams

SharePoint

Job description

Join to apply for the Program Manager II - Medicare/Marketplace Claims role at Arizona Complete Health.

3 days ago Be among the first 25 applicants.

Join to apply for the Program Manager II - Medicare/Marketplace Claims role at Arizona Complete Health.

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.

Position Purpose: This Program Manager II will support AZ Complete Health by planning, organizing, monitoring, and overseeing programs utilizing cross-functional teams to deliver defined requirements and meet business needs and strategic objectives.

The ideal candidate will have a strong background in project management, data analysis, and healthcare operations (emphasis on claims and configuration), with expertise in Medicare and Marketplace programs. They should be skilled in driving cross-functional collaboration, analyzing complex data to support decision-making, and identifying process improvements that enhance efficiency and compliance.

In this role, you will:

• Leverage data analysis skills to run queries, pull claims data, and identify trends, providing insights that support decision-making and issue resolution.
• Apply knowledge of billing and reimbursement rules, specifically for Medicare and Marketplace, to support claims analysis and ensure program compliance.
• Serve as the primary liaison between Provider Engagement, Internal Medicare Operations/Value Based team, and Shared Services, ensuring alignment and effective collaboration.
• Ensure that all Medicare and Marketplace deliverables, including claim-related metrics, reference materials, and policies/procedures, meet quality and turnaround standards.
• Drive process improvements by identifying gaps and collaborating with teams to implement changes that enhance efficiency and outcomes.
• Support claims issue resolution by identifying trends, troubleshooting escalated claims concerns, and working with internal teams to ensure timely and accurate claims processing.
• Support initiatives that promote quality, safety, and cost of care opportunities.
• Gather requirements, create plans and schedules, manage resources, and facilitate project execution and deployment.
• Utilize industry-standard tools and techniques to oversee programs according to department procedures.
• Maintain detailed business process documentation.
• Create and monitor all department deliverables to ensure adherence to quality standards.
• Communicate program status to management and stakeholders.
• Identify resources, resolve issues, and mitigate risks.
• Identify requirements and problems to improve processes.
• Coordinate cross-functional meetings to meet stakeholder expectations and business objectives.
• Manage projects through their full lifecycle.
• Provide leadership and communicate project status effectively.
• Negotiate with stakeholders to secure resources, resolve issues, and mitigate risks.
• Perform other duties as assigned and ensure compliance with policies and standards.

Education/Experience:

• Bachelor's degree in a related field or equivalent experience.
• 3+ years of project management experience.
• Healthcare experience preferred.

This role requires a balance of analytical, project management, and communication skills to drive Medicare and Marketplace initiatives.

Technical/Software Skills:

• Data analysis & reporting proficiency in SQL or similar query languages.
• Experience with project management tools like Microsoft Project or Smartsheet.
• Proficiency in Microsoft Office Suite, especially Excel, PowerPoint, Word/OneNote.
• Familiarity with collaboration tools like Microsoft Teams and SharePoint.

*Applicants can work remotely from anywhere in the continental US. The ideal schedule is 8am - 5pm MST (Arizona time).*

Pay Range: $68,700 - $123,700 annually.

Centene offers comprehensive benefits including health insurance, 401K, stock plans, tuition reimbursement, paid time off, and flexible work options. Actual pay will be based on skills, experience, and other factors. Benefits are subject to eligibility.

Centene is an equal opportunity employer committed to diversity. All qualified applicants will receive consideration without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other protected characteristics.