Medicaid Claims Processing Remote Jobs in Raleigh, NC

Top Skills' Details

Medicaid Claims data and State Health Plan Claims data management

Project management - Jira and Asana tools

Description

Our Client is seeking an experienced Claims Project Manager to lead and coordinate healthcare data and claims-related initiatives supporting NC HealthConnex, Medicaid stakeholders, the North Carolina State Health Plan, managed care organizations, healthcare providers, and statewide health information exchange programs.

Key Responsibilities

Project Leadership

Lead healthcare and claims-related projects from initiation through implementation and operational transition.

Develop and maintain project plans, timelines, risks, issues, and dependencies.

Facilitate project meetings, stakeholder working sessions, and governance reviews.

Coordinate activities across state agencies, healthcare organizations, vendors, and internal business and technical teams.

Ensure project objectives, scope, deliverables, and timelines are effectively managed.

Claims and Healthcare Data Initiatives

Manage projects involving:

Eligibility data

Encounter data

Claims processing

Claims remittance

Provider data

Beneficiary assignment

Enrollment data

HIPAA 834 and 837 transactions

Support initiatives focused on healthcare interoperability, data exchange, and data quality.

Coordinate business and technical requirements gathering and documentation.

Assist with process improvement and operational optimization efforts.

Stakeholder Engagement

Serve as a liaison between state agencies, health plans, healthcare providers, vendors, and internal project teams.

Facilitate cross-functional collaboration among operational, business, analytics, and technical groups.

Manage stakeholder communications, expectations, and project reporting.

Support governance, decision-making, and issue resolution processes.

Project Management and Governance

Manage project risks, issues, action items, and decisions.

Create and maintain executive-level status reports and project documentation.

Support project governance and reporting requirements.

Ensure project artifacts are maintained within approved project management systems.

Tools and Methodologies

Utilize project management and collaboration tools including:

Asana

Jira

Microsoft Office Suite

Microsoft Teams

Apply Agile, Waterfall, or hybrid delivery methodologies as appropriate.

Required Qualifications

Bachelor's degree in Healthcare Administration, Business Administration, Information Technology, Public Health, or a related field.

Minimum of 5+ years of project management experience supporting healthcare claims, payer operations, Medicaid programs, healthcare data initiatives, or comparable healthcare operational environments.

Demonstrated experience managing complex projects involving multiple business and technical stakeholders.

Experience working with healthcare claims data and claims-related business processes.

Strong organizational, facilitation, and communication skills.

Experience developing project plans, status reports, and governance documentation.

Ability to manage competing priorities and deliver results in a fast-paced environment.

Preferred Qualifications

Experience supporting:

Medicaid programs

Managed care organizations

Healthcare payers

Health Information Exchanges (HIE)

State government healthcare initiatives

Working knowledge of:

Claims adjudication and remittance processes

Eligibility and enrollment operations

Encounter submissions

Provider network data

Data quality and validation processes

HIPAA-compliant healthcare transactions, including 834 and 837 formats

PMP, PMI-ACP, CSM, or other project management certifications.

Desired Skills

Healthcare claims operations

Medicaid program knowledge

Stakeholder management

Business process improvement

Requirements gathering and documentation

Executive communications

Risk and issue management

Vendor coordination

Data quality and reporting oversight

Strategic planning and execution

Work Location

Remote work permitted.

This position will allocate approximately 50% of its effort supporting Medicaid claims data initiatives and 50% supporting State Health Plan claims data initiatives. The successful candidate will manage projects involving healthcare claims processing, data exchange, interoperability, data quality, analytics, and operational improvements across both programs.

The Project Manager will operate within a matrixed environment and collaborate closely with program leadership, business operations teams, data quality teams, healthcare partners, state agencies, and technical stakeholders to ensure successful project delivery and operational outcomes.

Skills

Project management, jira, asana, claims management

Top Skills Details

Project management,jira,asana,claims management

Additional Skills & Qualifications

state experience is a plus

Experience Level

Intermediate Level

This is a Contract position based out of Raleigh, NC.

The pay range for this position is $50.00 - $65.00/hr.

Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following: • Medical, dental & vision • Critical Illness, Accident, and Hospital • 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available • Life Insurance (Voluntary Life & AD&D for the employee and dependents) • Short and long-term disability • Health Spending Account (HSA) • Transportation benefits • Employee Assistance Program • Time Off/Leave (PTO, Vacation or Sick Leave)

This is a fully remote position.

This position is anticipated to close on Jul 27, 2026.

We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company.

The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

We’re a leading provider of business and technology services. We accelerate business transformation for our customers. Our expertise in strategy, design, execution and operations unlocks business value through a range of solutions. We’re a team of 80,000 strong, working with over 6,000 customers, including 80% of the Fortune 500 across North America, Europe and Asia, who partner with us for our scale, full-stack capabilities and speed. We’re strategic thinkers, hands-on collaborators, helping customers capitalize on change and master the momentum of technology. We’re building tomorrow by delivering business outcomes and making positive impacts in our global communities. TEKsystems and TEKsystems Global Services are Allegis Group companies. Learn more at TEKsystems.com.

The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

San Francisco Fair Chance Ordinance: Pursuant to the San Francisco Fair Chance Ordinance, for all positions located in the city and county of San Francisco, we will consider for employment qualified applicants with arrest and conviction records.

Massachusetts Lie Detector: It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.

Use of Artificial Intelligence (AI): We may use Artificial Intelligence (AI) to support parts of our hiring process, including sourcing, screening, and evaluating candidates. AI helps assess applications and qualifications, but final decisions are made by our hiring team. By applying, you acknowledge and agree that your application may be reviewed using AI tools.