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Medicare Operations Jobs (NOW HIRING)

AlohaCare

Pharmacy Technician

Honolulu, HI · On-site

$17.25 - $21/hr

Oversight of PBM operations in regard to Medicare Part D and Part B delegated operations through auditing operational reports and utilizing the PBMs processing platforms. * Issue resolution of Part D ...

AlohaCare

Pharmacy Technician

Honolulu, HI

$17.25 - $21/hr

Oversight of PBM operations in regard to Medicare Part D and Part B delegated operations through auditing operational reports and utilizing the PBM's processing platforms. * Issue resolution of Part ...

Emergent Holdings

Medicare Sales Consultant

Detroit, MI · On-site

Advanced knowledge of call center operations The individual sales consultant is responsible for ... Presents individual Medicare Advantage product benefits, including annual AEP and age-in meetings ...

Infinx Healthcare

AR Specialist | Medicare

$19 - $23/hr

The Hospital Medicare Biller will: * Process accounts receivable payments and adjustments ... This role is critical in enabling efficient revenue cycle operations through robust AR management.

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Medicare Operations information

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How much do medicare operations jobs pay per hour?

As of Jun 19, 2026, the average hourly pay for medicare operations in the United States is $21.30, according to ZipRecruiter salary data. Most workers in this role earn between $16.83 and $24.28 per hour, depending on experience, location, and employer.

Is being a MOA a good entry level job?

A Medical Office Assistant (MOA) role in Medicare operations is often considered an entry-level position that involves administrative tasks, data entry, and customer service. It typically requires basic computer skills and knowledge of healthcare procedures, making it accessible for those starting in healthcare administration.

What are some common challenges faced in a Medicare Operations role and how can they be addressed?

Professionals in Medicare Operations often encounter challenges such as staying compliant with frequently changing CMS regulations, managing a high volume of member inquiries, and coordinating effectively across departments like claims, customer service, and provider relations. To address these, it’s important to stay updated on regulatory changes through regular training, utilize robust workflow and documentation tools, and foster clear communication within cross-functional teams. Adopting a proactive approach and leveraging technology can greatly improve efficiency and accuracy in this dynamic environment.

What jobs pay 10,000 a month without a degree?

In Medicare operations, high-paying roles such as senior claims analysts, compliance managers, or healthcare consultants can reach or exceed $10,000 per month with extensive experience and specialized knowledge. These positions often require strong understanding of healthcare policies, data analysis skills, and certifications rather than formal degrees. Many of these roles are found in management or specialized consulting within the healthcare industry.

What is the difference between Medicare Operations vs Medicare Claims Specialist?

AspectMedicare OperationsMedicare Claims Specialist
CertificationsKnowledge of Medicare policies, possibly CMS certificationsLikewise, familiarity with Medicare claims processing, often with similar certifications
Work EnvironmentHealthcare organizations, insurance companies, government agenciesHealthcare providers, insurance companies, claims processing centers
Job FocusOverseeing Medicare program administration, policy complianceProcessing and reviewing Medicare claims for reimbursement

Medicare Operations and Medicare Claims Specialist roles share similar certifications and work environments, but differ mainly in scope. Medicare Operations focuses on managing the overall Medicare program and ensuring compliance, while Medicare Claims Specialists handle the detailed processing of claims for reimbursement. Both roles are essential in the healthcare and insurance industries, often overlapping in skills and knowledge areas.

Does Medicare pay for operations?

Medicare operations coverage depends on the specific procedure and medical necessity. Medicare Part A generally covers inpatient hospital stays, surgeries, and related care, while Part B covers outpatient surgeries and certain outpatient services. Healthcare providers must follow Medicare guidelines to determine coverage eligibility for surgical procedures.

What jobs pay 2000 a day?

In Medicare Operations, high-paying roles such as senior management, compliance directors, or specialized consultants can earn around $2,000 per day, especially with extensive experience and certifications. These positions often require advanced knowledge of healthcare regulations, strong analytical skills, and the ability to manage complex projects within healthcare organizations.

What are Medicare Operations?

Medicare Operations refers to the administrative and logistical processes involved in managing Medicare health insurance programs. This includes tasks such as enrolling beneficiaries, processing claims, handling customer service inquiries, ensuring compliance with federal regulations, and coordinating with healthcare providers. Professionals in Medicare Operations work to ensure that Medicare recipients receive their benefits accurately and efficiently while adhering to complex government guidelines. Their work is essential for the smooth functioning of the Medicare system.

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

To thrive in Medicare Operations, you need a solid understanding of healthcare regulations, Medicare policies, and experience with claims processing or healthcare administration. Familiarity with systems like CMS (Centers for Medicare & Medicaid Services) portals, claims adjudication software, and sometimes certification in healthcare compliance (such as CHC or CPC) is valuable. Strong attention to detail, analytical thinking, and effective communication are essential soft skills in this field. These skills and qualifications ensure accurate and compliant processing of Medicare claims, contributing to organizational efficiency and regulatory adherence.
More about Medicare Operations jobs
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What states have the most Medicare Operations jobs? States with the most job openings for Medicare Operations jobs include:
What job categories do people searching Medicare Operations jobs look for? The top searched job categories for Medicare Operations jobs are:
Medicare Operations jobs near you

Medicare Sales Support Operations Lead

Novus Group

Pittsburgh, PA • Hybrid

$37.40/hr

Full-time

Retirement, PTO

Posted 17 days ago

Job description

Medicare Sales Support Operations Lead

Role Type: Full-Time, Employee of the Company (Not a temp or contract assignment)

Shift: Monday–Friday, Daylight hours (Occasional evening or Saturday shifts may be required based on business needs or peak enrollment periods)

Work Arrangement: Hybrid (On-site with some work-from-home flexibility)

Location: Pittsburgh, PA 15219

New Hire Starting Salary Range: $22.52 – $26.24 per hour, to start

About the Opportunity

This is a permanent, full-time leadership career opportunity within a major regional insurance and managed care division. If selected, you will be hired directly as a regular employee of the organization we represent. You will be on their payroll and eligible for their full suite of benefits from your start date. This is not a temporary, contract, or "temp-to-hire" role. This position offers a dynamic hybrid workspace, combining cooperative on-site operations at a premier downtown corporate headquarters with remote flexibility.

Purpose

The Medicare Sales Support Operations Lead provides vital day-to-day leadership, operational coordination, and advanced functional support to the Medicare & Special Needs Plans (SNP) sales assistance team. The primary objective is to drive health plan membership growth and retention by overseeing phone-based outreach, broker support activities, enrollment workflows, and CRM database accuracy. Serving as a primary escalation point, this leader ensures strict compliance with federal guidelines while directly fostering the coaching, performance, and operational readiness of frontline representatives.

Responsibilities
  • Daily Team Leadership: Provide guidance, coaching, and real-time support to sales support representatives to maintain service, compliance, and enrollment standards.
  • Workload & Queue Management: Monitor team inbound/outbound queues, staff schedules, and coverage metrics to consistently meet strict service level expectations during standard operations and peak seasonal periods.
  • Escalation Resolution: Serve as the first-level escalation point for complex broker, member, or enrollment issues requiring advanced research, case resolution, or cross-functional coordination.
  • Regulatory Compliance: Maintain advanced operational knowledge of Medicare regulations, Centers for Medicare & Medicaid Services (CMS) guidelines, and internal policies to minimize organizational compliance risks.
  • Quality Assurance & Auditing: Oversee routine quality reviews, call recordings, and audits related to telephonic enrollments and CRM data entry to identify trends and mitigate process risks.
  • Performance Analytics: Utilize CRM platforms and reporting tools to monitor team metrics, track performance indicators, and support data-driven operational decisions.
  • Training & Documentation: Support the onboarding and continuous development of new hire personnel through structured feedback, while creating and maintaining training job aids and desk guides.
  • Cross-Functional Collaboration: Partner actively with internal Sales, Enrollment, Workforce Management, Training, Quality, and IT groups to resolve time-sensitive operational discrepancies.
Minimum Essential Requirements
  • High School Diploma or GED.
  • Minimum of two years’ experience in an Insurance, Managed Care, or Benefits Administration environment
  • Technical Proficiency: Strong PC skills with advanced keyboard dexterity and proficiency navigating MS Office applications and enterprise CRM systems.
  • Analytical & Communication Skills: Strong analytical ability to evaluate performance data, paired with excellent organizational, interpersonal, and verbal/written communication skills.
  • Leadership Development Pathway: Must successfully complete the organization's internal health plan leadership training track and receive a formal certificate of completion within one year of hire or transfer into the role.
Future Performance-Based Earning Potential
This role offers a structured path for financial advancement. Through consistent high performance, leadership development, and continuous learning over time, employees have the opportunity to earn up to $37.40 per hour.

Premier Benefits
  • Exceptional Retirement Package: Retirement plans with employer matching. Combined, the organization contributes up to 8% of your eligible pay toward your future.
  • World-Class Healthcare: Access preventive care and specialty services through an exclusive provider network.
  • Generous Paid Time Off: Enjoy up to 5.5 weeks of PTO per year, plus 7 paid holidays, with unique options to buy or sell PTO days to fit your lifestyle.
  • Tuition Assistance: Benefit from up to $6,000 per academic year in tuition reimbursement, plus exclusive tuition discounts at over 30 partner colleges and universities.