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Medicare Operations Analyst Jobs (NOW HIRING)

Bcbsa

Responsible for overseeing day-to-day operational work streams that support Medicare products and ... Strong analytical skills with ability to interpret utilization data, competitive benchmarking, and ...

Bcbsa

Responsible for overseeing day-to-day operational work streams that support Medicare products and ... Strong analytical skills with ability to interpret utilization data, competitive benchmarking, and ...

Bcbsa

Responsible for overseeing day-to-day operational work streams that support Medicare products and ... Strong analytical skills with ability to interpret utilization data, competitive benchmarking, and ...

Bcbsa

Responsible for overseeing day-to-day operational work streams that support Medicare products and ... Strong analytical skills with ability to interpret utilization data, competitive benchmarking, and ...

Bcbsa

Responsible for overseeing day-to-day operational work streams that support Medicare products and ... Strong analytical skills with ability to interpret utilization data, competitive benchmarking, and ...

Bcbsa

Responsible for overseeing day-to-day operational work streams that support Medicare products and ... Strong analytical skills with ability to interpret utilization data, competitive benchmarking, and ...

Blue Cross and Blue Shield of Kansas Inc.

Responsible for overseeing day-to-day operational work streams that support Medicare products and ... Strong analytical skills with ability to interpret utilization data, competitive benchmarking, and ...

Bcbsa

Medicare Operations Senior Program Manager

Ohio, IL · On-site +1

Responsible for overseeing day-to-day operational work streams that support Medicare products and ... Strong analytical skills with ability to interpret utilization data, competitive benchmarking, and ...

Bcbsa

Responsible for overseeing day-to-day operational work streams that support Medicare products and ... Strong analytical skills with ability to interpret utilization data, competitive benchmarking, and ...

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Medicare Operations Analyst information

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How much do medicare operations analyst jobs pay per hour?

As of Sep 10, 2026, the average hourly pay for medicare operations analyst in the United States is $33.75, according to ZipRecruiter salary data. Most workers in this role earn between $24.04 and $40.38 per hour, depending on experience, location, and employer.

What is a Medicare Operations Analyst?

Medicare Operations Analysts are professionals who oversee and enhance the operational processes associated with Medicare insurance programs. They analyze data, monitor regulatory compliance, and identify areas for process improvement within healthcare organizations or insurance companies. Their responsibilities often include preparing reports, ensuring claims are processed accurately, and implementing new policies or procedures to align with Medicare regulations. By streamlining workflows and maintaining compliance, they help organizations deliver efficient and effective services to Medicare beneficiaries.

What are some common challenges faced by a Medicare Operations Analyst in ensuring compliance with regulatory requirements?

Medicare Operations Analysts often face the challenge of staying up-to-date with frequently changing regulations and policies from CMS (Centers for Medicare & Medicaid Services). This requires continuous monitoring and interpretation of new guidelines to ensure that all operational processes remain compliant. Additionally, analysts must communicate changes effectively to cross-functional teams and help implement process adjustments without disrupting service quality. Strong analytical skills and attention to detail are essential to address these challenges and maintain compliance in a fast-paced environment.

What are the key skills and qualifications needed to thrive as a Medicare Operations Analyst, and why are they important?

To thrive as a Medicare Operations Analyst, you need a strong understanding of Medicare regulations, data analysis, and healthcare operations, often supported by a bachelor's degree in healthcare administration, business, or a related field. Familiarity with data analytics tools (such as Excel, SQL, or Tableau), claims processing systems, and CMS platforms is typically required. Attention to detail, problem-solving abilities, and effective communication are standout soft skills for this role. These skills ensure accurate compliance, efficient workflow optimization, and clear reporting within the complex Medicare environment.

What cities are hiring for Medicare Operations Analyst jobs?

Cities with the most Medicare Operations Analyst job openings:

What states have the most Medicare Operations Analyst jobs?

States with the most job openings for Medicare Operations Analyst jobs include:

What are popular job titles related to Medicare Operations Analyst jobs?

For Medicare Operations Analyst jobs, the most frequently searched job titles are:

Infographic showing various Medicare Operations Analyst job openings in the United States as of September 2026, with employment types broken down into 1% As Needed, 84% Full Time, 12% Part Time, 1% Temporary, 1% Contract, and 1% Nights. Highlights an 93% Physical, 2% Hybrid, and 5% Remote job distribution, with an average salary of $70,210 per year, or $33.8 per hour.

Medicare Operations Senior Program Manager

On-site, Remote

Bcbsa
See more jobs at Bcbsaexternal

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 10 days ago

Key responsibilities

  • Oversee day-to-day operational work streams supporting Medicare products and services to ensure compliance and operational efficiency.

  • Manage business requirements, system implementations, UAT, and change management in collaboration with cross-functional stakeholders.

  • Monitor operational performance, identify gaps, and implement in-year corrections to maintain product integrity and compliance.

Job description

This role will be responsible for operations management of the Federal Employee Program (FEP) Medicare Advantage (MA) EGWP line of business. Responsible for overseeing day-to-day operational work streams that support Medicare products and services to ensure operational/regulatory compliance consistent with FEP, Office of Personnel Management (OPM), and Centers for Medicare and Medicaid Services (CMS), and EGWP policies and procedures. Manage operational efficiencies/continuous improvement initiatives and support operational implementation of cross-functional initiatives to enhance member and provider experiences.
This position partners closely with FEPOC MA Operations, Compliance, Product, Clinical, Network, and Inter Plan & Products (IPP) teams to ensure product builds are compliant, timely, and operationally sound. Position will serve as the primary interface with operations and implementation partners throughout the product cycle and will play a critical role in driving the success of the company's product portfolio by delivering products that meet business objectives.
  • Manages business requirements, system implementations, UAT, and change management in partnership with the FEP Operations Center and cross-functional stakeholders. Ensures adherence to FEP program and ITS processes/procedures and applies deep Medicare Advantage regulatory and operational expertise to ensure CMS compliance and audit readiness.
  • Manages pre/post-launch operational monitoring, identifies execution gaps, and drives in-year corrections to maintain product integrity and compliance.
  • Relationship management skills to build and maintain a positive, collaborative working relationship across various internal and external functional areas/stakeholders. Establish cohesive relationships and influence decisions without having a direct functional reporting structure. Build trust, exhibit sense of urgency, drive consensus in resolving conflicts and decision making. Resolve or escalate issues, propose alternatives and set or manage expectations in a timely fashion.
  • Manages product implementation and operational readiness as directed by product development team in ensuring benefit builds at the operations and implementation partner level align precisely with approved CMS-compliant specifications. Support enrollment, member services, provider network operations, ANOC/EOC planning, and member experience initiatives.
  • Supports Product Development team with strategic planning, multi-year operational roadmaps, and process optimization using Lean Six Sigma and industry benchmarking. Manages vendor relationships, contracts, and RFPs; represent MA operations in governance forums and with CMS.
  • Manages collating MA product operational performance reporting including all applicable KPIs, SLAs, regulatory, and operational reporting metrics and appropriately distributes to BCBSA leadership.
  • Serves as a liaison and communicator to FEPOC Operations team, presenting recommendations to leadership and mentoring operational staff.

The posting range for this position is:

105,400.00 - 152,800.00


Qualifications:
Education

  • Required BS in Healthcare, Business Administration, Public Health, or related field; or equivalent experience

Experience

  • Required 8+ Years experience in Medicare/Medicare Advantage Operations, healthcare operations, and health insurance or managed care.


Knowledge Skills and Abilities

  • Deep knowledge of Medicare Advantage, Part D, and CMS regulations.
  • Experience leading/supporting large, cross functional programs/projects, including working with TPAs/BPOs.
  • Experience working with core processing platforms like - Facets, HealthEdge, QNXT etc.
  • Strong analytical skills with ability to interpret utilization data, competitive benchmarking, and quality/Stars metrics to drive benefit enhancement decisions.
  • Excellent written, oral communication, and presentation skills; proven ability to develop and deliver executive-level materials and represent product initiatives to senior stakeholders.
  • Proficiency in Microsoft Office (Word, Excel, PowerPoint); familiarity with project management tools and data visualization platforms.
  • Strong stakeholder management and relationship-building skills with the ability to influence without authority across Legal, Compliance, Actuarial, Clinical, and Operations functions.


Extra Posting Information:

#LI-Remote

The posted salary range is the lowest to highest salary we, in good faith, believe we would pay for this role at the time of this posting. We may ultimately pay more or less than the hiring range and this hiring range may also be modified in the future. A candidate's position within the hiring range may be based on several factors including, but not limited to, specific competencies, relevant education, qualifications, certifications, relevant experience, skills, seniority, performance, shift, travel requirements, and business or organizational needs.This job is also eligible for annual bonus incentive pay.

We offer a comprehensive package of benefits including paid time off, 11 holidays, medical/dental/vision insurance, generous 401(k) matching, lifestyle spending account and many other benefits to eligible employees.

Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation 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.

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