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Medicare Operations Manager Jobs (NOW HIRING)

Addus HomeCare

Home Care Operations Manager

Tyler, TX · On-site

Coordinate and manage all business and financial affairs and other operational activities related ... Follows all Medicare, Medicaid, and HIPAA regulations and requirements * Abides by all regulations ...

Addus HomeCare

Home Care Operations Manager

Tyler, TX · On-site

Coordinate and manage all business and financial affairs and other operational activities related ... Follows all Medicare, Medicaid, and HIPAA regulations and requirements * Abides by all regulations ...

Addus HomeCare

Home Care Operations Manager

Tyler, TX

Coordinate and manage all business and financial affairs and other operational activities related ... Follows all Medicare, Medicaid, and HIPAA regulations and requirements * Abides by all regulations ...

Mosaik Medical

Pharmacy Operations Manager

Bend, OR · On-site

... operations, including revenue growth, expense management, budget adherence, and potential ... Partners with 340B Coordinator and accounting to review and reconcile Medicare Transaction ...

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Medicare Operations Manager information

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$31K

$63.5K

$118.5K

How much do medicare operations manager jobs pay per year?

As of Jun 30, 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 is the highest paying job in healthcare management?

In healthcare management, executive roles such as Chief Executive Officer (CEO), Chief Operating Officer (COO), and Chief Financial Officer (CFO) tend to be the highest paying positions, often earning six-figure salaries or more. These roles require extensive experience, leadership skills, and often advanced degrees like an MBA or healthcare administration certification.

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.

Is ops manager higher than GM?

In most organizations, a General Manager (GM) typically holds a higher or broader leadership position than an Operations Manager (Ops Manager). The GM oversees multiple departments or the entire business unit, while the Ops Manager focuses specifically on managing daily operations within a department or area. The hierarchy can vary depending on the company's structure, but generally, the GM has greater overall responsibility.

What is a medicare manager?

A Medicare Operations Manager oversees the administration and compliance of Medicare insurance programs within an organization. They coordinate claims processing, ensure adherence to regulations, and often use healthcare management software to optimize operations. Strong knowledge of Medicare policies and leadership skills are essential for this role.

What are the 7 roles of an operations manager?

An operations manager is responsible for overseeing daily business activities, managing staff, ensuring efficient processes, implementing policies, coordinating between departments, monitoring performance metrics, and optimizing resource use. In a healthcare setting like Medicare, they also ensure compliance with regulations and improve service delivery. Strong leadership, organizational skills, and familiarity with healthcare systems are essential for this role.
More about Medicare Operations Manager jobs
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 June 2026, with employment types broken down into 99% Full Time, 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.
Claims Analyst

Claims Analyst

Clever Care Health Plan

Huntington Beach, CA • Remote

$88K - $100K/yr

Full-time

Posted 29 days ago

Job description

 Applicants must be located in Southern California in Los Angeles or Orange County,

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 Claims Analyst will work with the Senior Director of Medicare Operations in identifying potential areas for process improvement initiatives to support development of automation, payment accuracy, audit activities, business rules and P&Ps. Claim analyst is responsible for the end to end process for any configuration and automation projects

Functions & Job Responsibilities

· Includes claims systems utilization, capacity analyses/planning and reporting including claims-related business and systems analysis

· Excellent analytical, problem solving and troubleshooting activities.

· Must be able to analyze requirements for any Claim related projects

· Provide configuration support based on business needs including but not limited to DOFR, Benefits, and MOOP.

· Evaluate and Analyze any business needs including but not limited to DOFR, Benefits, and MOOP related to Claims Department.

· Review and recommend improvement to current configuration

· Document and Report to Senior Claims analyst and Director of Medicare Operations

· Perform Test Cases

· Run Test, study and analyze result, and troubleshoot if necessary

· Ability to pull and analyze reports necessary to support claim department needs

· Validating accuracy of reports produced and submitted by the Claims Department.

· Assists in preparing and reviewing cases for regulatory and other health plan reports and requirements.

· Ensure adherence to state and federal compliance policies, reimbursement policies, and contract compliance

· Assists in validating claim compliance reports

· Create Business Requirement Document as needed

· Create CMS Reports as needed by Director of Operations

· Manage and support new projects and regulatory updates in accordance with CMS

Qualifications

Education/Experience:

· High School diploma or equivalent required. Associate degree or an equivalent combination of education and claims processing experience preferred. Bachelor’s degree in related field (preferred).

· 2 to 5 years of experience in a managed care claims processing environment required

· Demonstrate knowledge of applicable claims processes (e.g., end-to-end claims cycle, auto-adjudication, manual work processes, payment methodologies, rework/adjustment processes)

· Terminology, CPT, revenue codes, ICD10, HCPCS codes as it relates to claims processing adjudication. Core claims processing systems and healthcare authorization systems.

Skills:

· Perform in a fast-paced environment and work under pressure.

· Communicate clearly and concisely, both verbally and in writing to individuals of diverse backgrounds.

· Organize, plan and prioritize work activities, possess analytical and problem-solving skills.

· Troubleshoot claims adjudication problem areas.

· Encourage and utilize suggestions and new ideas.

· Comprehend and interpret provider contracts and Divisional Financial of Responsibility (DOFR).

· Utilize and access computer and appropriate software (e.g., Microsoft: Word, Excel, PowerPoint) and job-specific applications/systems (e.g., EZCAP Claims Processing System and Authorization system) to produce correspondence, charts, spreadsheets, and/or other information applicable to the position.

Wage Range: $88,000.00 to $100,000.00 per year

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.

Clever Care Health Plan is proud to be an Equal Employment Opportunity and Affirmative Action workplace. Individuals seeking employment will receive consideration for employment without regard to race, color, national origin, religion, age, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender perception or identity, age, marital status, disability, protected veteran status or any other status protected by law. A background check is required. 

  

Salary ranges posted on the job posting are based on California wages. Salary may be higher or lower depending on the candidate’s state residency. 

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