Program Manager- Ohio Claims

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

Program Manager-Ohio MyCare

Location: It is required to reside in Ohio. This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace.

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless accommodation is granted as required by law.

The Program Manager will be responsible for Ohio Claims for Medicaid line of business, ensuring resolution to claims configuration issues, rate changes, compliance and contractual updates. Program managers typically support business strategies through an integrated portfolio of external client facing projects or initiatives. A program manager may have responsibility for a piece of a larger enterprise/regional external client facing program.

How you will make an impact:

• Work collaboratively with claims teams, provider experience, utilization management, regulatory and call center leads to resolve issues and concerns as they relate to claims policies, reimbursement policies, codes requiring authorizations, and provider complaints.

• Accountable for on time delivery of regulatory reports related to claims (i.e. Prompt Pay, Claims Disputes and others).

• Manages and coordinates the development, approval, implementation and compliance of on-going external client facing programs.

• Researches applicable subject matter practices and remains aware of industry trends.

• Manages external client facing relationships and partners with corporate and regional business areas.

• Develops program success measures and performs periodic assessments of program success.

• Oversee the end-to-end claims process, including receipt, adjudication, payment, and performance reporting on claims timeliness, accuracy, backlog and provider payment compliance.

• Serve as the operational liaison with the state of Ohio, Provider Experience, and internal executive leadership.

Minimum Requirements: Requires a BA/BS and minimum of 5 years external client facing experience in program/project management; or any combination of education and experience, which would provide an equivalent background.

Preferred Skills, Capabilities and Experiences:

• Graduate degree preferred.

• Project management certification preferred.

• Strong understanding of Dual (Medicare and Medicaid) claims configuration & adjudication is strongly preferred.

• Experience with regulatory reporting development, accuracy, and submission preferred.

For candidates working in person or virtually in the below locations, the salary* range for this specific position is $92,720.00 to $139,080.00.

Location(s): Columbus, OH

In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.

• The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education, and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process should submit the Accessibility Accommodation Request Form (https://forms.cloud.microsoft/pages/responsepage.aspx?id=8giMvgesLESaRuvu61vU17EJaA0EP3FIissI8zmZ_NpUNUgyTFRUMkY5NE5JNDFWMkhaUzQxMkJLWS4u&route=shorturl) and a member of the team will be in contact.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration (https://info.flclearinghouse.com/).