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Medicare Operations Manager Jobs in Texas (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 popular job titles related to Medicare Operations Manager jobs in Texas?

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

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

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

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

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

Medicare Operations Manager jobs near you
Infographic showing various Medicare Operations Manager job openings in Texas as of August 2026, with employment types broken down into 1% As Needed, 85% Full Time, 10% Part Time, 1% Temporary, 2% Contract, and 1% Nights. Highlights an 93% Physical, 3% Hybrid, and 4% Remote job distribution.

Senior Client Services Agent (Medicare)

Lone Star National Bank

San Antonio, TX • On-site

$14 - $18.75/hr

Other

Posted 27 days ago

Job description

SUMMARY
A Medicare Team Lead oversees a team responsible for assisting clients with Medicare plans, ensuring compliance with regulations, and providing excellent customer service. They are responsible for monitoring performance, providing training, and resolving escalated issues to improve efficiency and member satisfaction. Contracts of licensing, budgets and forecasting.
ESSENTIAL DUTIES
The duties listed below may not include all responsibilities that the person in this role may be asked to perform. Incumbent may be required to perform other related duties as assigned.
  • Supervise and motivate a team of agents or specialists, ensuring daily operations run smoothly.
  • Track and optimize team metrics, including sales conversion rates, production targets, and call quality.
  • Ensure all operations comply with Medicare regulations and Lone Star Insurance Services policies.
  • Act as the primary point of contact and subject matter expert for resolving complex member or provider issues.
  • Lead training sessions in San Antonio & the Rio Grande Regions, develop job aids, and mentor new hires, especially during the annual enrollment period.
  • Identify areas for improvement in workflows and implement changes to enhance efficiency
  • Forecasting opportunities during peak open enrollment period
  • Maintain referral programs work closely with Branches and partners to uncover opportunities.
  • Maintains current knowledge of internal risk controls and loss prevention, including reporting of suspicious or unusual customer activity per Lone Star National Bank and Lone Star Insurance Services policy
  • Maintains current knowledge and complies with all federal and state laws and regulations and all established Lone Star National Bank and Lone Star Insurance Services policies and procedures, including internal audit controls related to department operations
  • Maintains current knowledge of all rules, regulations, and laws as they apply to BSA/OFAC/USA Patriot Act/CIP/AML

These specifications are general guidelines based on the minimum experience normally considered essential to the satisfactory performance of this position. The requirements listed below are representative of the knowledge, skill and/or ability required to perform the position in a satisfactory manner. Individual abilities may result in some deviation from these guidelines.
  • 5+ years of sales management, sales leadership, or Medicare-specific experience (Medicare Advantage, Part D, Drug RX, Supplement,). (Required)
  • Bachelor's degree preferred or equivalent work experience.
  • Active Health/Life insurance license, with the ability to pass AHIP Certification
  • Strong understanding of Centers for Medicare & Medicaid Services rules and regulations.
  • Strong communication, interpersonal, and problem-solving skills.
  • Proficiency with computer systems, including Microsoft Office and Customer Relationship Management (CRM) tools.
  • Passionate about delivering high-quality service to Medicare members.
  • Ability to mediate disputes and handle escalated situations effectively.
  • Proven ability to set, achieve, and exceed performance targets.
  • Ability to work in a fast-paced environment and handle changing requirements.
  • Ability to sell products within licenses obtained
  • Ability to travel to San Antonio and the Rio Grande Valley, Texas
  • Bilingual in English and Spanish (preferred)

ORGANIZATION
  • This position reports to the Insurance Office Manager
  • This position oversees the Client Services Agents (Medicare)

TRAINING REQUIREMENTS
All employees are required to attend scheduled mandatory trainings and complete online regulatory compliance training courses applicable to their specific job function. In all situations, employees must ensure that their actions fully comply with all federal insurance laws and regulations, including internal company policies and procedures. Failure to adhere to these requirements will be grounds for disciplinary action, including probation and possible termination.
COMMUNITY INVOLVEMENT
Lone Star Insurance Services' Mission Statement includes a commitment to helping our communities grow by serving them with pride and integrity. All employees are encouraged to volunteer for company sponsored activities, civic, charitable and community events and to be active in the communities we serve.
LSIS is an Equal Opportunity/Affirmative Action Employer and does not discriminate in the recruitment, hiring, and conditions of employment on the basis of race, color, religion, national origin, sex (including pregnancy), sexual orientation, gender identity, marital status, disability, age, veteran status, or any other status as protected by applicable laws.
Management reserves the right to change this position description at any time according to business needs.

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