Texas Medicaid Operations Specialist - Hybrid Texas

Health Care Service Corp.; Richardson (TX); Hybrid; USD 85,000 - 120,000; Full time

Job summary

Health Care Service Corporation is seeking an experienced operations professional to support Texas Medicaid managed care functions, including Utilization Management, Care Management, reporting, and compliance. You will coordinate across teams to implement policies and system changes that satisfy UMCM and contract requirements.

The role emphasizes data-driven monitoring, performance evaluation, and corrective actions, with a hybrid schedule in Richardson or Austin, TX.

Qualifications

• Must have a Bachelor Degree in Business with 4 years’ experience OR 8 years of experience in health insurance operations.
• Experience in project development, implementation and execution skills.
• Strong verbal and written communication, and ability to represent Medicaid department at meetings.
• Experience interfacing with internal clients and operations personnel.
• Ability to manage multiple projects effectively and work with all levels of stakeholders.
• Interpersonal, organizational and analytical skills; leadership capabilities.

Responsibilities

• Provide operational services, assistance, and program coordination for Medicaid functions (UM/CM, reporting, compliance, billing, claims, enrollment, customer service).
• Resolve complex internal or external operational questions and support testing and implementation of policies and system changes.
• Monitor performance using data and reporting; identify gaps and coordinate corrective actions.

Skills

Project management

Excel

Power BI

Data analysis

Communication

Leadership

Education

Bachelor Degree in Business

Job description

At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers. Join HCSC and be part of a purpose-driven company that will invest in your professional development.

Job Summary

This position is responsible for providing operational services, assistance, and program implementation and coordination for one or more of the day-to-day Medicaid operational functions, including Utilization Management (UM), Care Management (CM), reporting, compliance, billing, claims, enrollment, and customer service. This resource is responsible for resolving complex and/or escalated internal or external operational questions. Additionally, this position works with other areas of the organization on the development, testing, and implementation of program policies, business processes, reporting solutions, and system changes to ensure the state requirements of the plan are met. The role will have a particular focus on Texas Medicaid managed care operations, including interpreting and supporting requirements outlined in the Texas Medicaid and CHIP Uniform Managed Care Manual (UMCM) and applicable managed care contracts, while using data and reporting to monitor operational performance, identify gaps, and support compliance.

Required Job Qualifications:

• Bachelor Degree in Business with 4 years’ experience OR 8 years of experience working in health insurance operations
• Experience in project development, implementation and execution skills
• Experience interfacing with internal clients, operations personnel
• Verbal and written communication skills and ability to represent Medicaid department at committee meetings
• Experience with interacting effectively with all levels of internal and external customers
• Experience managing multiple projects effectively
• Interpersonal, organizational and analytical skills
• Organizational and leadership skills

Preferred Job Requirements:

Experience with managing contract provisions Experience in Project Management Direct experience supporting Texas Medicaid managed care operations, preferably within a Medicaid Managed Care Organization (MCO), healthcare services organization, delegated entity, or vendor supporting a Texas Medicaid population. Working knowledge of the Texas Medicaid and CHIP Uniform Managed Care Manual (UMCM) and the Uniform Managed Care Contract (UMCC) requirements to ensure that and the and experience interpreting or applying UMCM requirements to operational processes, reporting, deliverables and , or compliance activities are compliant. Hands‑on experience with Texas Medicaid Utilization Management (UM) and/or Care Management (CM) operations. Experience working with or interpreting Texas Medicaid managed care contract requirements, including the relationship between contract requirements, UMCM guidance, and operational execution. Experience monitoring operational performance or compliance, identifying gaps, validating deliverables/data, and coordinating corrective actions or operational improvements. Strong reporting and data‑analysis skills, including advanced Microsoft Excel; Power BI/dashboard development or reporting experience strongly preferred. Experience with managing contract provisions Experience in Project Management Ability to analyze complex Medicaid operational requirements and translate them into clear business requirements, processes, reporting, and actionable recommendations.

Location:

Richardson, TX or Austin, TX offices

Schedule:

This is a Flex (Hybrid) role: 3 days in office; 2 days remote.

Sponsorship:

Sponsorship is not available

#LI-Hybrid #LI-JR2

Pay Transparency Statement:

At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting https://careers.hcsc.com/totalrewards. The compensation offered will vary depending on your job‑related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan.

HCSC Employment Statement:

We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.

For more than 80 years, HCSC has been dedicated to expanding access to high‑quality, cost‑effective health care and equipping our members with information and tools to make the best health care decisions for themselves and their families. As an industry leader, HCSC also has been helping to make the health care system work better for all Americans. To remain a leader, we offer compelling careers that encourage resourcefulness, strategic thought and empower you to make a difference in the lives of our members and their communities. Today, with the industry at an important crossroad, HCSC is reimagining health care and looking for original thinkers who aren’t afraid to make innovative contributions. We are an Equal Opportunity Employment employer dedicated to workforce diversity and a drug‑free and smoke‑free workplace. Learn more about HCSC, our commitment to our members and the opportunity you’ll have to improve health care delivery in an open, collaborative environment. HCSC is committed to diversity in the workplace and to providing equal opportunity to employees and applicants.

If you are an individual with a disability or a disabled veteran and need an accommodation or assistance in either using the Careers website or completing the application process, you can call us at 1-866-977-7378 to request reasonable accommodations. Please note that only requests for accommodations in the application process will be returned. All applications, including resumes, must be submitted through HCSC's Career website on-line application process.

Blue Cross and Blue Shield of Illinois, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of New Mexico, Blue Cross and Blue Shield of Oklahoma, and Blue Cross and Blue Shield of Texas, Divisions of Health Care Service Corporation, a Mutual Legal Reserve Company, and Independent Licensee of the Blue Cross and Blue Shield Association © Copyright 2025 Health Care Service Corporation. All Rights Reserved.