Senior Medicaid Claims Operations Leader

Conduent; Montgomery (AL); On-site; USD 77,770 - 101,000; Full time

Benefits offered by this job

Health and Welfare Benefits

Retirement Savings

Employee Discounts

Career Growth Opportunities

Paid Training

Paid time off

Great Work Environment

Job summary

Conduent is seeking an Operations Claims Processing Manager to lead Medicaid Claims Processing operations and serve as the primary contact for claim-related functions. This role provides leadership across Claims Resolution, Drug Rebate, Medical Policy, Financial Transactions, and Data Entry, ensuring regulatory compliance and SLA/KPI achievement.

The ideal candidate will be an experienced Medicaid operations leader with deep knowledge of CMS regulations and state plan requirements, capable of

Qualifications

• Bachelor's degree or equivalent in a related field.
• Eight+ years in Medicaid claims processing or major healthcare payer operations.
• Experience leading claims processing teams and complex operational functions.
• Strong knowledge of Medicaid claims processing, reimbursement methods and operations.
• Experience managing operational metrics, SLA performance, and KPI reporting.
• Excellent written, verbal, and presentation communication skills.
• Analytical, organizational, and problem-solving abilities.
• Ability to thrive in a fast-paced, high-volume environment and pass background checks.

Responsibilities

• Serve as the primary contact for all Medicaid Claims Processing operations.
• Manage Claims Resolution, Drug Rebate, Medical Policy, Financial Transactions, and Data Entry.
• Define and maintain operational policies and procedures.
• Identify opportunities for process improvement and drive initiatives.
• Lead, coach, and develop claims processing teams.
• Ensure adherence to processes, policies, and compliance requirements.
• Monitor tools and systems to support efficient claims processing.
• Own and drive achievement of SLAs and KPIs.
• Analyze performance metrics and report to leadership.
• Coordinate with CMS regulations, Medicaid policy, and State Plan requirements.
• Collaborate with stakeholders to ensure accurate and timely claims processing.
• Manage escalated issues and implement corrective actions.

Skills

Leadership

Regulatory knowledge

SLA/KPI management

Data analysis

Operational coaching

Strong communication

Education

Bachelor's degree in Computer Science, Information Systems, Healthcare Administration, Business Administration, or related field

Tools

Medicaid claims processing software

CMS regulations knowledge

Job description

Conduent is seeking an Operations Claims Processing Manager to lead Medicaid Claims Processing operations and serve as the primary contact for claim-related functions. This role provides leadership across Claims Resolution, Drug Rebate, Medical Policy, Financial Transactions, and Data Entry, ensuring regulatory compliance and SLA/KPI achievement.

The ideal candidate will be an experienced Medicaid operations leader with deep knowledge of CMS regulations and state plan requirements, capable of