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Medicare Operations Manager 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 ...

Conduit Health

Operations Manager

New York, NY · On-site

$65K - $120K/yr

The Role We're looking for an Operations Manager to own Conduit's fulfillment and distribution ... You understand healthcare regulations (HIPAA, Medicare/Medicaid) and use them to set the bar with ...

Ovation Healthcare

Specialist, Medicare

The Ovation Healthcare difference is the extraordinary combination of operations experience and ... The Medicare Specialist is responsible for managing the billing and collection processes for ...

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How much do medicare operations manager jobs pay per year?

As of Jun 6, 2026, the average yearly pay for medicare operations manager in the United States is $63,456.00, according to ZipRecruiter salary data. Most workers in this role earn between $41,000.00 and $77,500.00 per year, depending on experience, location, and employer.

What is the difference between Medicare Operations Manager vs Medicare Claims Supervisor?

AspectMedicare Operations ManagerMedicare Claims Supervisor
Required CredentialsBachelor's degree in healthcare administration or related field; certifications like CPC or CMS certificationsHigh school diploma or associate's; certifications like CPC or claims-specific training
Work EnvironmentOversees multiple departments, manages staff, and ensures compliance in healthcare organizationsSupervises claims processing teams, reviews claims, and ensures accuracy in claims submission
Employer & Industry UsageHealth insurance companies, Medicare administrative contractors, healthcare providersHealth insurance companies, Medicare contractors, claims processing centers

The Medicare Operations Manager focuses on overseeing overall Medicare operations, including compliance and staff management, while the Medicare Claims Supervisor concentrates on managing claims processing and accuracy. Both roles require knowledge of Medicare policies and certifications like CPC, but differ in scope and responsibilities.

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

To thrive as a Medicare Operations Manager, you need expertise in healthcare administration, Medicare regulations, and process optimization, typically supported by a bachelor's degree in healthcare or business administration. Familiarity with CMS guidelines, claims processing systems, and compliance management tools is essential. Strong leadership, analytical thinking, and effective communication distinguish top performers in this role. These skills are crucial for ensuring regulatory compliance, operational efficiency, and high-quality service in the management of Medicare programs.

What are some of the main challenges faced by a Medicare Operations Manager, and how can they be addressed?

A Medicare Operations Manager often encounters challenges such as staying current with frequently changing CMS regulations, ensuring data accuracy, and coordinating across multiple departments to maintain compliance and operational efficiency. Addressing these challenges involves maintaining robust communication channels, investing in ongoing staff training, and leveraging technology to automate reporting and auditing processes. Building strong relationships with compliance, IT, and customer service teams also helps streamline workflows and foster a proactive approach to problem-solving.

What are Medicare Operations Managers?

Medicare Operations Managers are professionals responsible for overseeing the daily operations of Medicare-related services within healthcare organizations or insurance companies. They ensure compliance with federal regulations, manage teams that process Medicare claims, and work to optimize workflows and efficiency. Their role also involves monitoring performance, implementing policy changes, and coordinating with other departments to ensure high-quality service for Medicare beneficiaries. These managers play a critical role in maintaining regulatory standards and improving overall operational effectiveness.
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What cities are hiring for Medicare Operations Manager jobs? Cities with the most Medicare Operations Manager job openings:
What are the most commonly searched types of Medicare Operations jobs? The most popular types of Medicare Operations jobs are:
What states have the most Medicare Operations Manager jobs? States with the most job openings for Medicare Operations Manager jobs include:
What job categories do people searching Medicare Operations Manager jobs look for? The top searched job categories for Medicare Operations Manager jobs are:
Medicare Operations Manager jobs near you
Infographic showing various Medicare Operations Manager job openings in the United States as of May 2026, with employment types broken down into 1% As Needed, 85% Full Time, 12% Part Time, 1% Temporary, and 1% Contract. Highlights an 90% Physical, 1% Hybrid, and 9% Remote job distribution, with an average salary of $63,456 per year, or $30.5 per hour.
Medicare Operations Configuration Analyst

Medicare Operations Configuration Analyst

Clever Care Health Plan

Huntington Beach, CA

Full-time

Posted 26 days ago

Job description

This position is not available for visa sponsorship.

Applicants must be located in Southern California.

Are you ready to make a lasting impact and transform the healthcare space? We are one of Southern California’s fastest-growing Medicare Advantage plans with an incredible 112% year-over-year membership growth.  

Who Are We?  

Clever Care was created to meet the unique needs of the diverse communities we serve. Our innovative benefit plans combine Western medicine with holistic Eastern practices, offering benefits that align with our members’ culture and values. 

Why Join Us? 

We’re on a mission! Our rapid growth reflects our commitment to making healthcare accessible for underserved communities. At Clever Care, you’ll have the opportunity to make a real difference, shape the future of healthcare, and be part of a fast-moving, game-changing organization that celebrates diversity and innovation. 

Job Summary

The Medicare Operations Configuration Analyst oversees the system development and configuration activities and file exchange processes of the Enrollment department while ensuring its processes operate smoothly. The Medicare Operations Configuration Analyst also works with other internal stakeholders, customers, vendors, and with federal and State agencies to resolve eligibility issues in order for the plan to continue receiving payment for medical services provided.

Functions & Job Responsibilities

· Assists in the configuration of the Eligibility Manager and EzCap Eligibility Modules to facilitate processing and storage of enrollment data.

· Analyze, review, monitor, and control the Enrollment file reconciliation operation with efficiency and effectiveness.

· Assists with the design/revision and implementation of internal departmental systems and procedures.

· Coordinate file production for the submission and monitoring of daily, weekly and monthly inventory reports to determine departmental efficiency and maintain the integrity of the enrollment file.

· Assists the Enrollment team to ensure timely and accurate completion of all required eligibility documents, accurate recording of assessments, and guaranteeing productivity standards.

· Coordinate interdepartmental projects with other areas of the organization; including Retention, IT, Marketing departments, Compliance, and Provider Relations.

· Work closely with the Local department of Social Service, HRA, and Maximus to ensure timely submissions and resolution of eligibility issues, as well as establishing departmental goals and ensuring quality goals are met.

· Analyze workflows, identify deficiencies, and develop more efficient processes.

· Prepare enrollment analysis and enrollment reports for the Manager of Enrollment.

· Oversee surplus billing and work closely with the Finance department in the reconciliation of capitation payments.

· Direct the implementation of Medicare regulations and related products.

· Serve as a subject matter expert and coordinate departmental procedures.

· Ensure compliance with company and statutory policies.

· Develop departmental policy and procedural documentation.

· Ensure the required member mailings are sent in a timely fashion.

· Run ongoing reports for various Medicare Operations Key Performance Indicators

· Develop summaries from reports for management to develop action plans and interventions.

· Assist with creating benchmarks for various Medicare Operations teams to ensure teams are operating efficiently.

· Assist with creating data visualization models to help convey complex data sets in a simplified and easy to digest manner.

· Develop AD-HOC reports as the necessity presents itself.

· Other duties as assigned

Qualifications

Education and Experience:

· Three (3) years’ healthcare industry experience, preferably with Medicare Advantage plan or Managed Care

· Two (2) to four (4) years progressive work experience in business or health operations preferred.

Skills:

· Deep understanding of government programs including Medicare Advantage

· Expert knowledge of Medicare reimbursement methodologies.

· Strong knowledge of Medicare Sound judgment, tact, and discretion, with the ability to work with Company employees at all level

· Strong interpersonal skills and the ability to establish a rapport with all levels of an organization.

· Strong customer service skills.

· Exceptional written and verbal communication skills.

· Ability to convey complex or technical information in a manner that is easy to understand.

· Intermediate computer knowledge, Excel, Word, PowerPoint, prominence, ACD system, Adobe Acrobat.

· Intermediate SQL skills for data querying and analysis

· Experience with data visualization tools such as Tableau, Quicksight or Power BI

Physical & Working Environment.

Physical requirements needed to perform the essential functions of the job, with or without reasonable accommodation:

• Must be able to travel when needed or required

• Ability to operate a keyboard, mouse, phone and perform repetitive motion (keyboard); writing (note-taking)

• Ability to sit for long periods; stand, sit, reach, bend, lift up to fifteen (15) lbs.

Ability to express or exchange ideas to impart information to the public and to convey detailed instructions to staff accurately and quickly.

Work is performed in an office environment and/or remotely. The job involves frequent contact with staff and public. May occasionally be required to work irregular hours based on the needs of the business.

This is an exciting opportunity for a dedicated professional to contribute to the success of our Medicare Operations and make a positive impact on the delivery of healthcare services to our members. If you are passionate about healthcare administration and have a keen eye for data and detail, we encourage you to apply for this position.

Apply