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Payer Operations Manager Jobs in Georgia (NOW HIRING)

Ra

Health Care Analyst (Medicare)

Atlanta, GA · Remote

Who holds 2+ years' experience in US Payer operations & US Payer system implementations! Who is ... Who holds 2+ years Program management, full lifecycle project, SDLC, Agile, Waterfall, SCRUM ...

CYNET SYSTEMS

Business Analysis

Columbus, GA · On-site

$55 - $60/hr

... requirements management, or transformation programs. * Healthcare domain experience is required ... * Healthcare payer operations, claims quality, G&A, appeals, regulatory workflows, or audit ...

UCB

Commercial Operations Analyst

Atlanta, GA · Hybrid

About the Role You will be responsible for supporting payer and Pharmacy Benefit Manager (PBM) contracting operations with significant financial and operational impact. This role ensures the timely ...

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Payer Operations Manager information

What is a payer operations manager?

A Payer Operations Manager oversees the administrative and operational functions related to health insurance payers, such as insurance companies or managed care organizations. Their responsibilities typically include managing claims processing, ensuring compliance with regulatory requirements, optimizing reimbursement processes, and working to improve relationships between healthcare providers and payers. They play a crucial role in streamlining operations, improving efficiency, and ensuring that payments are accurate and timely. Payer Operations Managers often collaborate with a variety of stakeholders, including internal teams, insurance partners, and healthcare providers.

What are some typical challenges faced by a payer operations manager, and how can they be addressed?

Payer Operations Managers often navigate complex relationships between healthcare providers, insurance companies, and internal teams. Common challenges include managing regulatory changes, streamlining claims processing, and ensuring compliance with payer contracts. Addressing these requires strong communication skills, staying up-to-date with industry regulations, and leveraging technology to automate workflows. Building collaborative relationships across departments is essential to efficiently resolve issues and maintain service quality.

What are the key skills and qualifications needed to thrive as a payer operations manager, and why are they important?

To thrive as a Payer Operations Manager, you need expertise in healthcare operations, payer-provider relations, and a strong understanding of insurance regulations, typically backed by a bachelor’s degree in healthcare administration or a related field. Familiarity with claims management systems, EDI transactions, and data analytics tools is crucial. Strong leadership, problem-solving abilities, and effective communication skills help you manage teams and resolve operational challenges efficiently. These competencies ensure streamlined payer processes, regulatory compliance, and improved healthcare outcomes.

What is the difference between Payer Operations Manager vs Payer Account Manager?

AspectPayer Operations ManagerPayer Account Manager
Primary FocusOversees payer processes, claims, and reimbursement operationsManages relationships and negotiations with specific payer accounts
Required SkillsClaims processing, compliance, operational workflowsCustomer service, account management, negotiation skills
Work EnvironmentOperations teams, healthcare organizations, insurance companiesSales, client relations, account management teams
CertificationsTypically requires healthcare or insurance certificationsOften requires sales or account management certifications

The Payer Operations Manager focuses on the internal processes related to payer reimbursements and claims, ensuring smooth operations. In contrast, the Payer Account Manager concentrates on maintaining and growing relationships with specific payer clients. Both roles require healthcare industry knowledge but serve different functions within the payer ecosystem.

What cities in Georgia are hiring for Payer Operations Manager jobs?

Cities in Georgia with the most Payer Operations Manager job openings:

    Infographic showing various Payer Operations Manager job openings in Georgia as of August 2026, with employment types broken down into 88% Full Time, 11% Part Time, and 1% Contract. Highlights an 93% Physical, 3% Hybrid, and 4% Remote job distribution.

    Program Manager, Payer Operations (Alma)

    Atlanta, GA • Remote

    Spring Health
    Offices of Mental Health Practitioners • 201 - 500 employees

    7.4

    Company rating: 7.4 out of 10

    Based on 9 frontline employees who took The Breakroom Quiz

    Good employer

    Respectful managers

    Good training

    Learn more about Spring Healthexternal

    Full-time

    Medical, Dental, Vision, Retirement, PTO

    Posted 14 days ago

    Job description

    Our mission: eliminating every barrier to mental health.

    Spring Health is a global mental health company on a mission to eliminate every barrier to mental health. We're building a world where getting support is simple, personal, and built around the person, so care can continue through every job, move, health plan, and life stage.
    Our AI-native platform helps us deliver personalized support across self-guided tools, coaching, therapy, medication management, and specialty care. With outcomes independently validated by JAMA Network Open and the Validation Institute, Spring Health reaches more than 170 million people worldwide through leading employers, health plans, and partners.
    As an AI-native company, we believe technology should expand the reach, quality, and humanity of care. Every Spring Health team member is expected to use AI tools thoughtfully, apply human judgment to AI outputs, and keep building AI fluency in ways that support their role and our mission.

    Alma, a Spring Health Company, is on a mission to simplify access to high-quality, affordable mental health care. We do this by making it easy and financially rewarding for therapists to accept insurance and offer in-network care. When a provider joins Alma, they gain access to a suite of tools that not only help them better run their business, but also grow it sustainably and develop as a provider. Alma is available in all 50 states, with over 20,000 therapists in our growing network. Anyone looking for a therapist can browse Alma's free directory. Alma has raised $220.5M in funding from Insight Partners, Optum Ventures, Tusk Venture Partners, Primary Venture Partners, First Round Capital, Sound Ventures, BoxGroup, Cigna Ventures, and Rainfall Ventures. Alma was also named one of Inc's Best Workplaces in 2022 and 2023.

    Candidate Interview Guide 

    Alma is looking for a Program Manager to join our Payer Success team within Operations. In this role, you'll be the central quarterback for our payer partnerships in steady-state operations – the person who holds the full picture across the end-to-end RCM lifecycle, from credentialing and rostering to claims adjudication to CX. You won't be expected to solve every issue yourself, but you will be the one making sure nothing falls through the cracks: tracking open issues, mobilizing the right internal experts, and driving accountability across teams until problems are resolved. You'll work closely across all teams at Alma, in particular within Operations and Business Development, to turn operational insights into action and improve outcomes across our payer portfolio. This is a full time, fully remote position on our team. Occasional travel may be required for team or company events/meetings. 

    What you'll do

    • Track open payer issues end-to-end, ensuring clear ownership, visibility, and accountability across cross-functional teams until resolution
    • Drive measurable business outcomes by improving RCM efficiency and effectiveness, with the ultimate goal of increasing revenue performance and delivering a better experience for Alma providers and their clients
    • Partner closely with internal operations teams to connect the dots across stakeholders, subteams, and workflows - surfacing interdependencies and ensuring issues move to resolution rather than stall
    • Serve as the primary operational point of contact for BD counterparts, triaging and coordinating new requirements surfaced by the payer and claims, roster, complaints, and escalation issues across assigned payers
    • Partner with the Business Development Team on payer calls to drive RCM discussions, align stakeholders, and move issues to resolution
    • Proactively monitor for new payer requirements and evolving payer mergers, and mobilize the right internal teams to implement changes before they become problems
    • Track and report on RCM performance by payer - surfacing trends, flagging risks, and ensuring the right teams are engaged to drive improvement

    What success looks like: 

    • Portfolio RCM performance improvement (e.g., denial rate, reimbursement, AR days)
    • Portfolio payers meeting performance goals
    • On-time completion of payer initiatives/projects
    • Completion and maintenance of payer health assessments/business reviews
    • Stakeholder satisfaction (internal and payer partners)

    Who you are

    • Experienced in healthcare operations - you understand how insurance claims and payer relationships actually work
    • A strong cross-functional collaborator who can align people across teams without direct authority
    • Highly organized with a track record of managing complex, multi-stakeholder projects from kickoff through launch
    • Comfortable in ambiguity - you can proactively identify what needs to happen next without waiting to be told
    • A clear communicator who can distill operational complexity for both internal partners and external payer contacts
    • Detail-oriented and data-driven, with the ability to monitor performance metrics and translate them into action

    Benefits:

    • We're a remote-first company
    • Health insurance plans through Aetna (medical and dental) and MetLife (vision), including FSA and HSA plans
    • 401K plan (ADP)
    • Lifestyle Spending Account for health, wellness, and family care
    • Monthly co-working space membership stipend
    • Monthly work-from-home stipend
    • Financial wellness benefits through Northstar
    • Pet discount program through United Pet Care
    • Financial perks and rewards through PerkSpot
    • EAP access through Aetna
    • One-time home office stipend to set up your home office
    • Inclusive family and medical leave plans
    • 12 paid holidays and 1 Alma Give Back Day
    • Flexible PTO 

    The target base salary range for this position is $97,000 - $113,500. All Alma jobs are listed on our careers page. We do not use outside applications or automated text messaging in our recruiting process. We will not ask for any sensitive financial or identification information throughout the recruiting process. Any communication during the recruitment process, including interview requests or job offers, will come directly from a recruiting team member with a helloalma.com email address.

    Not sure if you meet every requirement? Research shows that women and people from historically underrepresented communities often hesitate to apply for roles unless they meet every qualification compared to other similarly-qualified candidates. At Spring Health, we are committed to fostering a workplace where everyone feels valued, empowered, and supported to Thrive. If this role excites you, we encourage you to apply.

    Our privacy policy: https://springhealth.com/privacy-policy/

    Spring Health is proud to be an equal opportunity employer. We do not discriminate in hiring or any employment decision based on race, color, religion, national origin, age, sex, marital status, ancestry, disability, genetic information, veteran status, gender identity or expression, sexual orientation, pregnancy, or other applicable legally protected characteristic. We also consider qualified applicants regardless of criminal histories, consistent with applicable legal requirements. Spring Health is also committed to providing reasonable accommodations for qualified individuals with disabilities and disabled veterans. If you have a disability or special need that requires accommodation, please let us know.

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