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Medicare Operations Jobs (NOW HIRING)

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 ...

Stance Health Solutions

MEDICARE SPECIALIST

CA · On-site

$23.67 - $29.77/hr

Flexible and adaptable to changing business needs, particularly in a growing Medicare-focused operation * Proficiency in billing systems and Microsoft Office 365; experience with Brightree or similar ...

Wipro Limited

Medicare BPO

Jefferson City, MO · On-site

Medicare BPO City: Jefferson City State/Province: Missouri Posting Start Date: 6/5/26 Wipro Limited ... Background in healthcare operations or claims processing is advantageous. Skills and Knowledge

Stance Health Solutions

MEDICARE SPECIALIST

La Crescenta, CA · On-site

$23.67 - $29.77/hr

Flexible and adaptable to changing business needs, particularly in a growing Medicare-focused operation * Proficiency in billing systems and Microsoft Office 365; experience with Brightree or similar ...

Shepherd Insurance

Medicare Specialist

Indianapolis, IN · On-site

Identify process improvements and contribute to enhancing operational workflows across the Medicare division. * Perform other related duties as assigned. Requirements * Complete annual training for ...

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Medicare Operations information

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$31

How much do medicare operations jobs pay per hour?

As of Jul 11, 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.

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 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.

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
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 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
Infographic showing various Medicare Operations job openings in the United States as of July 2026, with employment types broken down into 4% As Needed, 77% Full Time, 15% Part Time, and 4% Contract. Highlights an 90% Physical, 1% Hybrid, and 9% Remote job distribution, with an average salary of $44,307 per year, or $21.3 per hour.
Medicare Membership & Eligibility Analyst (Temporary)

Medicare Membership & Eligibility Analyst (Temporary)

Central California Alliance for Health (Remote)

Hollister, CA • On-site, Remote

$36 - $48/hr

Full-time, Temporary

Medical, Dental, Vision, Retirement, PTO

Posted 8 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.