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Medicare Operations Manager Jobs in California (NOW HIRING)

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Medicare Operations Manager information

What is a Medicare Operations Manager?

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.

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

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 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 most commonly searched types of Medicare Operations jobs in California?

The most popular types of Medicare Operations jobs in California are:

What are popular job titles related to Medicare Operations Manager jobs in California?

For Medicare Operations Manager jobs in California, the most frequently searched job titles are:

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

The top searched job categories for Medicare Operations Manager jobs in California are:

What cities in California are hiring for Medicare Operations Manager jobs?

Cities in California with the most Medicare Operations Manager job openings:

Medicare Operations Manager jobs near you
Infographic showing various Medicare Operations Manager job openings in California as of August 2026, with employment types broken down into 1% As Needed, 86% Full Time, 9% Part Time, 1% Temporary, 2% Contract, and 1% Nights. Highlights an 93% Physical, 3% Hybrid, and 4% Remote job distribution.

Medicare Membership & Eligibility Analyst (Temporary)

Sacramento, CA • On-site, Remote

Central California Alliance for Health (Remote)
See more jobs at Central California Alliance for Health (Remote)external

$36 - $48/hr

Full-time, Temporary

Re-posted 26 days ago

Job description

OUR COMMITMENT TO A HUMAN HIRING PROCESS

We believe every candidate deserves thoughtful consideration. That's why we do not use AI or automated systems to review applications. Every application is reviewed by a real human member of our team. Because we take the time to give each submission the attention it deserves, our review process may take a little longer — and we genuinely appreciate your patience as we work through applications carefully and respectfully.

SERVICE AREA PREFERENCE

While we encourage all interested applicants to apply, we do give priority to those who live in, or near, our service counties: Santa Cruz, Monterey, Merced, San Benito, and Mariposa. Our mission of accessible, quality health care guided by local innovation leads everything we do, and having team members who are connected to the communities we serve strengthens our ability to deliver on that commitment.

ABOUT THIS TEMP POSITION

This is a temporary position and the length of assignment is estimated to go until December 31, 2026. The length of the assignment is always dependent on business need and dates may change. While the assignment would be at the Alliance, if selected, you would be an employee of a temporary employment agency that we would connect you with.

WHAT YOU'LL BE RESPONSIBLE FOR

Reporting to the Medicare Operations Director, this position:

  • Supports Medicare operations, sales, and enrollment functions through analysis and interpretation
    of Medicare and Medi-Cal data and ensures compliance with applicable state and federal
    regulations
  • Conducts complex research and analysis in support of Medicare Operations activities
  • Acts as a subject matter expert and liaison to internal and external stakeholders
WHAT YOU'LL NEED TO BE SUCCESSFUL

To read the full position description and list of requirements, click here.

  • Knowledge of:
    • CMS guidelines related to Medicare sales and enrollment
    • Medicare Advantage enrollment processes and financial reconciliation
    • Contents and interpretation of monthly membership reports
    • Research, analysis, and reporting methods
    • Data analysis tools, CRM/enrollment systems, and the use of databases
  • Ability to:
    • Analyze complex data sets and present actionable insights
    • Identify issues, gather and analyze information and data, reach logical and sound conclusions, and make recommendations for action
    • Interpret, explain and apply applicable policies, laws, codes, regulations, and contracts
    • Organize work, manage multiple projects, establish priorities, adjust to changing priorities, and meet deadlines
    • Assist with the development and implementation of projects, systems, programs, policies, and procedures
    • Develop and implement operational workflows
  • Education and Experience:
    • Bachelor's degree in Business Administration, Health Care Administration, Public Health, or a related field
    • Minimum of five years of progressively responsible experience related to Medicare membership operations and/or enrollment eligibility
    • Master's degree may substitute for two years of the required experience; or an equivalent combination of education and experience may be qualifying
OTHER INFORMATION
  • We are in a hybrid work environment, and we anticipate that the interview process will take place remotely via Microsoft Teams.
  • While some staff may work full telecommuting schedules, attendance at quarterly company-wide events or department meetings will be expected.
  • In-office or in-community presence may be required for some positions and is dependent on business need. Details about this can be reviewed during the interview process.
  • This is a temporary position and does not provide the benefits that are listed below (this is standard language from our regular job posts and cannot be altered or removed). Temporary employees on assignment at the Alliance will be connected to a staffing agency with separate benefit options.

COMPENSATION INFORMATION

  • Zone 1 Pay Range: $36.00 - $48.00
    Typical areas in Zone 1: Santa Cruz, San Benito, and Monterey Counties, Bay Area, Sacramento, Los Angeles and San Diego areas
  • Zone 2 Pay Range: $34.00 - $45.00
    Typical areas in Zone 2: Mariposa and Merced Counties, Fresno area, Bakersfield, Eastern California, San Luis Obispo area, and the Central Valley (except Sacramento)

The applicable salary ranges are based on work location and are aligned to a zone according to the cost of labor in your area. All ranges are subject to change in the future. We are happy to answer any questions that you have or share the applicable pay zone for your location if it's not one of the typical areas listed. You can reach out to careers@thealliance.health, and a member from our Talent Acquisition team will be in touch.

The posted hiring ranges represent a good‑faith estimate of what a temporary employee would be paid on this assignment. Final compensation will be determined by our compensation philosophy, analysis of the selected candidate's qualifications (direct or transferable experience related to the position, education, or training), as well as other factors (internal equity, market factors, and geographic location).

OUR BENEFITS
  • Medical, Dental and Vision Plans
  • Ample Paid Time Off
  • 12 Paid Holidays per year
  • 401(a) Retirement Plan
  • 457 Deferred Compensation Plan
  • Robust Health and Wellness Program
  • Onsite EV Charging Stations
  • And many more
ABOUT US

We are a group of over 500 dedicated employees, committed to our mission of providing accessible, quality health care that is guided by local innovation. We feel that our work is bigger than ourselves. We leave work each day knowing that we made a difference in the community around us.

The Alliance is an equal employment opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender perception or identity, national origin, age, marital status, protected veteran status, or disability status. We are an E-Verify participating employer

Join us at Central California Alliance for Health (the Alliance) is an award-winning regional Medi-Cal managed care plan that provides health insurance for children, adults, seniors and people with disabilities in Mariposa, Merced, San Benito and Santa Cruz counties. We currently serve more than 418,000 members. To learn more about us, take a look at our Fact Sheet.

At this time the Alliance does not provide any type of sponsorship. Applicants must be currently authorized to work in the United States on a full-time, ongoing basis without current or future needs for any type of employer supported or provided sponsorship.