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Medicare Operations Jobs (NOW HIRING)

Centene

Sales Representative (Medicare)

$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)

$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)

$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)

Bronx, 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 ...

Centene

Sales Representative (Medicare)

$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)

Sunrise, FL · 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 ...

Centene

Sales Representative (Medicare)

Brooklyn, 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 ...

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 ...

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 PBMs processing platforms. * Issue resolution of Part D ...

Centene

Sales Representative (Medicare)

Manhattan, 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 ...

Centene

Sales Representative (Medicare)

New Hampton, 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 ...

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 ...

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Medicare Operations information

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How much do medicare operations jobs pay per hour?

As of Aug 21, 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 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 August 2026, with employment types broken down into 1% As Needed, 84% Full Time, 11% Part Time, 1% Temporary, 2% Contract, and 1% Nights. Highlights an 94% Physical, 2% Hybrid, and 4% Remote job distribution, with an average salary of $44,307 per year, or $21.3 per hour.

Senior Manager, Medicare Business Compliance

CVS Health

Blue Bell, PA • On-site

$82K - $182K/yr

Full-time

Medical, Dental, Vision, Retirement, PTO

Re-posted 11 days ago

CVS Health rating

5.8

Company rating: 5.8 out of 10

Based on 4,339 frontline employees who took The Breakroom Quiz

91st of 113 rated pharmacies

Job description

We're building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselvesaccountable and prioritize safety and quality in everything we do. Join us and be part of something bigger - helping to simplify health care one person, one family and one community at a time.

At Aetna, part of CVS Health, we proudly serve more than 26 million medical members through our broad range of health plan offerings. We're committed to delivering a simpler, more meaningful, and personal health care experience to each of them.

Asa Senior Manager Business Compliance (Medicare) you will play a critical role by leading and delivering complex compliance initiatives that support regulatory adherence and operational excellence. This role partners closely with cross-functional business areas to plan, coordinate, and execute projects that mitigate operational and regulatory risk, with a strong emphasis on Medicare compliance.

This position is a senior-level project management position within Operations Integrity and offers broad exposure to internal business partners and leadership teams and provides the opportunity to demonstrate leadership, strategic thinking, and enterprise-level influence.

In this role, you will:

  • Oversee the implementation and ongoing interpretation of Medicare laws, regulations, and regulatory guidance, ensuring timely and accurate execution across impacted business areas.
  • Serve as a subject matter resource for inquiries and lead responses to audit and data requests from regulators, auditors, and internal oversight partners.
  • Interpret regulatory guidance, assess compliance gaps, identify root causes, and design and implement sustainable corrective action plans.
  • Routinely communicate project status, risks, and outcomes to senior leaders and executive stakeholders, translating complex regulatory requirements into clear, actionable business guidance.
  • Oversight of new and updated regulatory guidance implementation, leadership of Annual Enrollment Period (AEP) readiness activities across multiple business areas, proactive identification and mitigation of operational risks, and end-to-end coordination of audit and regulatory responses.
  • Contributes to regulatory compliance, operational stability, and overall member satisfaction.


Required Qualifications

  • Project Management:5+ years of experience leading complex initiatives from planning through execution and delivery.
  • Systems Expertise:Hands-on experience with QuickBase.
  • Communication Skills:Demonstrated strong oral and written communication skills.
  • Executive Communication:Proven ability to communicate effectively with leaders at all levels, including executive leadership.
  • Problem Solving & Decision Making:Strong analytical skills with the ability to assess issues, evaluate options, and make sound decisions.
  • Collaboration & Teamwork:Adept at working collaboratively across cross-functional teams to achieve shared goals.
  • Growth Mindset:Demonstrated agility and commitment to continuous learning, development, and coaching of others.
  • Execution & Delivery:Strong capability in planning, delivering, and supporting initiatives to achieve intended outcomes.
  • Regulatory Expertise:Strong knowledge of Medicare regulations and regulatory guidance.

Preferred Qualifications

  • 5+ years Medicare operational experience
  • Aetna systems experience
  • Regulatory compliance experience


We support a hybrid work environment. If selected and you live near a suitable work location, you may be expected to comply with the hybrid work policy. Under the policy, all hires for in-scope populations should be placed into a hybrid or office-based location, working onsite three days a week.

Aetna Service Operations office/hub locations will be discussed with the selected candidate.


Education

  • Bachelor's degree or equivalent work experience

Pay Range

The typical pay range for this role is:

$82,940.00 - $182,549.00


This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company's equity award program.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

This fulltime position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial wellbeing of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.


Additional details about available benefits are provided during the application process and on Benefits Moments.

We anticipate the application window for this opening will close on: 08/15/2026

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

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