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Medicare Operations Jobs (NOW HIRING)

Conflux Systems

Medicare Domain SME

Medicare operations workflow This Expert must be able to play a leadership role in managing and coordinating the members of the BIA team. They must have excellent interpersonal skills, be self ...

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How much do medicare operations jobs pay per hour?

As of Aug 21, 2026, the average hourly pay for medicare operations in the United States is $21.30, according to ZipRecruiter salary data. Most workers in this role earn between $16.83 and $24.28 per hour, depending on experience, location, and employer.

What is Medicare Operations?

Medicare Operations refers to the administrative and logistical processes involved in managing Medicare health insurance programs. This includes tasks such as enrolling beneficiaries, processing claims, handling customer service inquiries, ensuring compliance with federal regulations, and coordinating with healthcare providers. Professionals in Medicare Operations work to ensure that Medicare recipients receive their benefits accurately and efficiently while adhering to complex government guidelines. Their work is essential for the smooth functioning of the Medicare system.

What are the key skills and qualifications needed to thrive in Medicare Operations?

To thrive in Medicare Operations, you need a solid understanding of healthcare regulations, Medicare policies, and experience with claims processing or healthcare administration. Familiarity with systems like CMS (Centers for Medicare & Medicaid Services) portals, claims adjudication software, and sometimes certification in healthcare compliance (such as CHC or CPC) is valuable. Strong attention to detail, analytical thinking, and effective communication are essential soft skills in this field. These skills and qualifications ensure accurate and compliant processing of Medicare claims, contributing to organizational efficiency and regulatory adherence.

What are some common challenges faced in a Medicare Operations role and how can they be addressed?

Professionals in Medicare Operations often encounter challenges such as staying compliant with frequently changing CMS regulations, managing a high volume of member inquiries, and coordinating effectively across departments like claims, customer service, and provider relations. To address these, it’s important to stay updated on regulatory changes through regular training, utilize robust workflow and documentation tools, and foster clear communication within cross-functional teams. Adopting a proactive approach and leveraging technology can greatly improve efficiency and accuracy in this dynamic environment.

What is the difference between Medicare Operations vs Medicare Claims Specialist?

AspectMedicare OperationsMedicare Claims Specialist
CertificationsKnowledge of Medicare policies, possibly CMS certificationsLikewise, familiarity with Medicare claims processing, often with similar certifications
Work EnvironmentHealthcare organizations, insurance companies, government agenciesHealthcare providers, insurance companies, claims processing centers
Job FocusOverseeing Medicare program administration, policy complianceProcessing and reviewing Medicare claims for reimbursement

Medicare Operations and Medicare Claims Specialist roles share similar certifications and work environments, but differ mainly in scope. Medicare Operations focuses on managing the overall Medicare program and ensuring compliance, while Medicare Claims Specialists handle the detailed processing of claims for reimbursement. Both roles are essential in the healthcare and insurance industries, often overlapping in skills and knowledge areas.

More about Medicare Operations jobs

What are the most commonly searched types of Medicare Operations jobs?

The most popular types of Medicare Operations jobs are:

What job categories do people searching Medicare Operations jobs look for?

The top searched job categories for Medicare Operations jobs are:

Medicare Operations jobs near you
Infographic showing various Medicare Operations job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 84% Full Time, 11% Part Time, 1% Temporary, 2% Contract, and 1% Nights. Highlights an 94% Physical, 2% Hybrid, and 4% Remote job distribution, with an average salary of $44,307 per year, or $21.3 per hour.

Director Medicare Operations

The James Allen Companies Inc

Kansas City, MO • On-site

$130 - $190/hr

Other

Posted 14 days ago

Job description

Director of Medicare Operations

This is not a Medicare sales or producer position. It is an operations, compliance, carrier contracting, technology, and team-development role focused specifically on building the organization's Medicare Supplement capabilities.

About the Organization

The organization provides an alternative to traditional group health benefits through a technology platform that serves brokers and employers. Employees use the platform to shop for individual health plans and enroll directly with the insurance carrier.

The company currently supports ACA and other non-Medicare individual health products. It is now adding a Medicare division and needs an experienced Medicare professional to build the operational infrastructure, compliance framework, carrier relationships, technology solutions, and internal team required to support the new business line.

The person in this position will report directly to Hunter.

Primary Responsibilities

The Director of Medicare Operations will:

  • Develop the company's Medicare Supplement operational model and supporting processes.
  • Establish compliant procedures for Medicare-related enrollments, communications, documentation, and agent activity.
  • Lead carrier contracting and appointment efforts with Medicare Supplement carriers.
  • Evaluate and help select technology solutions that support quoting, enrollment, compliance, reporting, and customer service.
  • Build and develop a Medicare operations team of approximately six employees.
  • Establish workflows, performance standards, training procedures, and quality controls for the team.
  • Work closely with leadership, technology, agency operations, brokers, carriers, and compliance partners.
  • Help scale the Medicare division as the company expands its services.
  • Ensure the Medicare operation integrates effectively with the organization's existing ACA and individual health platform.
Ideal Candidate Background

The strongest candidate will have significant experience with Medicare Supplement products and the operational requirements surrounding them.

The organization would prefer someone who has worked for an independent insurance agency, brokerage, field marketing organization, or similar organization where they were involved in developing or expanding a Medicare business.

The person should understand:

  • Medicare Supplement products and carrier requirements.
  • Medicare-related compliance and operational procedures.
  • Carrier contracting, appointments, licensing, and onboarding.
  • Agency operations and enrollment workflows.
  • Technology platforms used for quoting, enrollment, compliance, and customer management.
  • Team development, training, and performance management.
  • How to build processes and infrastructure within a growing organization.

Experience helping grow an agency, department, startup, or new division would be highly valuable.

What the Role Is Not

This position is not designed for someone whose Medicare experience has primarily consisted of selling policies directly to consumers.

The successful candidate does not need to be a traditional salesperson or business-development producer. The emphasis is on building and managing the operational foundation behind a Medicare Supplement business, including compliance, carrier relationships, technology, processes, and people.

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