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Medicare Operations Jobs (NOW HIRING)

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 ...

Centene

Vice President, Associate General Counsel

$171K - $326K/yr

Research, analyze, and interpret complex healthcare regulatory requirements, including but not limited to issues related to Medicare operations, risk adjustment, MLR, quality, stars, and agent ...

CorroHealth, Inc.

Medicare Specialists work with Medicare and/or Medicaid, and patients to resolve outstanding ... Fundamental operations of the revenue cycle are supported through our expert teams while we recast ...

AlohaCare

Pharmacy Technician - Oahu or Maui

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 ...

Twin Health

Director, Medicare Advantage Strategy

You will partner closely with Product, Clinical, Operations, Commercial, Marketing, and executive leadership to help shape Twin's Medicare Advantage strategy and member experience. You will bring an ...

Slalom Consulting

General Information

Chicago, IL · On-site

$60 - $70/hr

Deep understanding of Medicare operations, products, regulatory requirements, and business processes. * Experience supporting: * Medicare Advantage (MA) * Medicare Advantage Prescription Drug (MAPD)

Policy Pulse Innovations

Be Seen First

Medicare Sales Agent

Sunrise, FL · On-site

$60K - $100K/yr

... Medicare and related health coverage options ... We combine high-volume call center operations with field sales support across multiple states. Our ...

AlohaCare

Pharmacy Technician - Oahu or Maui

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 PBM's processing platforms. * Issue resolution of Part ...

AlohaCare

Pharmacy Technician - Oahu or Maui

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 - Oahu or Maui

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 ...

Centene

$48K - $82K/yr

Submit special reports regarding the operation of the territory, acceptance or rejection of ... Medicare required Bilingual in Spanish preferred: Specific language skills by some plans may be ...

Centene

Sales Representative (Medicare)

New York, NY · On-site +1

$48K - $82K/yr

Submit special reports regarding the operation of the territory, acceptance or rejection of ... Medicare required Bilingual in Spanish preferred: Specific language skills by some plans may be ...

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Medicare Operations information

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How much do medicare operations jobs pay per hour?

As of Sep 12, 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 is 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?

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.

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.

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 are popular job titles for Medicare Operations?

Popular job titles for Medicare Operations:

Medicare Operations jobs near you
Infographic showing various Medicare Operations job openings in the United States as of September 2026, with employment types broken down into 1% As Needed, 79% Full Time, 17% Part Time, 1% Temporary, 1% Contract, and 1% Nights. Highlights an 93% Physical, 2% Hybrid, and 5% Remote job distribution, with an average salary of $44,307 per year, or $21.3 per hour.

Medicare Specialist

Indianapolis, IN • On-site

Shepherd Insurance
Insurance Services • 201 - 500 employees
Learn more about Shepherd Insuranceexternal

Full-time

Re-posted 8 days ago

Key responsibilities

  • Manage the intake, organization, and closing of Medicare-related data with a focus on accuracy and compliance.

  • Oversee policy renewal processing using the AgencyBloc system to ensure data integrity and timely completion.

  • Navigate Medicare and carrier portals to perform provider searches, formulary and drug cost assessments, and benefit verification.

Job description

PURPOSE:
This is an ideal opportunity to work at a growing organization with a strong family culture. Shepherd Insurance is a privately-owned insurance agency that has delivered risk management solutions since 1977. With a wide variety of insurance and financial products, we are among the largest independent agencies in the country.
As a Medicare Specialist within the Shepherd family, you will serve as a knowledgeable support partner to the Licensed Agents - Medicare Insurance Division and team by executing specialized operational functions, ensuring compliance accuracy, enhancing workflow efficiency, and support the client and agent experience. With a positive attitude, you will provide strong attention to detail and the ability to navigate Medicare and carrier systems with accuracy and efficiency.
ROLES AND RESPONSIBILITIES
  • Mange the intake, organization and closing of Medicare-related data with a strong focus on accuracy and compliance.
  • Oversee policy renewal processing with AgencyBloc system, ensuring data integrity and timely completion.
  • Coordinate and prepare pre-appointment documentation, including Scope of Appointment forms and Client Intake Sheets, ensuring readiness for agent consultations.
  • Maintain and audit required sales documentation to ensure adherence to CMS and carrier guidelines.
  • Navigate Medicare and carrier portals to perform provider searches, formulary and drug cost assessments, and benefit verification at a specialist level.
  • Assist the Director of Medicare and team with ongoing and specialized data projects, often involving cross-system information gathering, cleanup and reporting.
  • Identify process improvements and contribute to enhancing operational workflows across the Medicare division.
  • Perform other related duties as assigned.

Requirements
  • Complete annual training for General Compliance and Fraud/Waste/Abuse.
  • Familiar with a variety of computer software applications including Microsoft Office products (Word, Excel, Outlook, PowerPoint).
  • Ability to work independently, manage multiple priorities, and adapt quickly to directional changes within the Medicare division.
  • Strong organizational skills, attention to detail and commitment to confidentiality.

EDUCATION AND EXPERIENCE REQUIREMENTS
  • Education requirement: High school diploma or equivalent (GED) is required. College degree is preferred, not necessary.
  • Experience: At least two (2) years' experience in similar position is desirable.

WORKING CONDITIONS/PHYSICAL DEMANDS
Work environment characteristics and physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is occasionally required to stand; walk; sit; use hands to finger, handle, or feel objects, tools or controls; reach with hands and arms; climb stairs; balance; stoop, kneel, crouch or crawl; talk or hear; taste or smell. The employee must occasionally lift and/or move up to 25 pounds. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus. While performing the duties of this job, the employee is not exposed to weather conditions. The noise level in the work environment is usually moderate

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