Program Manager II - Medicare/Marketplace Claims

Arizona Complete Health; Nevada (IA); Remote; USD 68,000 - 124,000; Full time

Job summary

An established industry player is seeking a Program Manager II to lead initiatives that enhance healthcare operations. This role involves leveraging data analysis to drive decision-making, ensuring compliance with Medicare and Marketplace programs, and collaborating across various teams to improve efficiency. The ideal candidate will have a strong project management background and experience in healthcare, focusing on claims and configuration. This position offers a flexible work environment, allowing you to work remotely from anywhere in the Continental United States while making a significant impact on the health of communities.

Benefits

Health Insurance

401K

Stock Purchase Plans

Tuition Reimbursement

Paid Time Off

Flexible Work Schedules

Qualifications

• Strong background in project management and healthcare operations.
• Proficiency in data analysis and SQL for claims data.

Responsibilities

• Oversee programs utilizing cross-functional teams to meet business needs.
• Drive process improvements and support claims issue resolution.

Skills

Data Analysis

Project Management

Healthcare Operations

Cross-Functional Collaboration

Process Improvement

Education

Bachelor's degree in related field

3+ years of project management experience

Tools

SQL

Microsoft Project

Microsoft Office Suite

Microsoft Teams

Job description

5 days ago Be among the first 25 applicants

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 as they will plan, organize, monitor, and oversee programs utilizing cross functional teams to deliver defined requirements and meet business needs and strategic objectives.

The ideal candidate for this Program Manager II role 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 Program Manager II 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 working 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 across these areas.
• Ensure that all Medicare and Marketplace deliverables, including claim-related metrics, reference materials, and policies/procedures, meet quality and turn-around standards.
• Drive process improvements by identifying gaps in existing procedures 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 business department initiatives that promote, quality, safety and cost of care opportunity
• Responsible for gathering requirements, creating plans and schedules, managing resources, and facilitate project execution and deployment.
• Utilize corporate and industry standard tools and techniques to effectively oversee programs according to department procedures.
• Maintain detailed business process documentation including meeting minutes, action items, issues lists and risk management plans as applicable
• Create and monitor all department deliverables to ensure adherence to quality standards including clinical reporting documents, related reference materials, and policy and procedure documentation.
• Communicate program status to management and key stakeholders.
• Identify resources, resolve issues, and mitigate risks.
• Identify requirements, procedures and problems to improve existing processes
• Coordinate cross-functional meetings with various functional areas to meet overall stakeholder expectations and business objectives
• Manage projects through the full project life cycle
• Provide leadership and effectively communicate project status to all stakeholders
• Negotiate with project stakeholders to identify and secure resources, resolve issues and mitigate risks
• Performs other duties as assigned
• Complies with all policies and standards
  
  

Education/Experience

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

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

Technical/Software Skills

• Data Analysis & Reporting Proficiency in SQL or other query languages to pull and analyze claims data.
• Project Management Tools Experience with Microsoft Project, Smartsheet, or similar tools for tracking initiatives and timelines.
• Microsoft Office Suite Strong proficiency in Excel (pivot tables, VLOOKUPs, data visualization), PowerPoint (presentations for leadership), and Word/OneNote (documentation).
• Collaboration & Communication Tools Familiarity with Microsoft Teams, SharePoint, or similar platforms for cross-functional coordination.
  
  

*Applicants for this job have the flexibility to work remote from home anywhere in the Continental United States. Due to the needs of the business, ideal schedule is 8am - 5pm MST (or Arizona time).*

Pay Range $68,700.00 - $123,700.00 per year

Centene offers a comprehensive benefits package including competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

Seniority level

• Seniority level

  Not Applicable

Employment type

• Employment type

  Full-time

Job function

• Job function

  Project Management and Strategy/Planning

• Industries

  Hospitals and Health Care and Insurance

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