Top 2 Claims operations manager Jobs in Montgomery Al

Medicaid Claims Operations Manager
General Dynamics Information Technology —Montgomery, AL
- $111,155 - $150,385 a year
- Hybrid work
- Background check
- 5 years
- Office
- Paid time off
- 401(k) matching
10d
Operations Claims Processing Manager
Conduent State Healthcare, LLC —Montgomery, AL
- $77,770 - $101,000 a year
- Email
- Background check
- Computer Science
- Office
- Paid training
- Paid holidays

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Medicaid Claims Operations Manager

General Dynamics Information Technology -
Montgomery, AL

Apply Now

Job Details

$111,155 - $150,385 a year
10 days ago

Benefits

Internal mobility program
Paid time off
401(k) matching

Qualifications

Bachelor's degree
NCQA standards
Project management experience in healthcare
Managing projects
Medicaid regulations
Medicaid

Full Job Description

Clearance Level

None

REQ#: RQ215262

Public Trust: Other

Requisition Type: Pipeline

Your Impact

Own your opportunity to work alongside federal civilian agencies. Make an impact by providing services that help the government ensure the well being and support of U.S. citizens.

Job Description

At General Dynamics Information Technology (GDIT), we support state agencies in streamlining Medicaid Enterprise Systems (MES) by delivering operational efficiency and excellence. We are seeking a Claims Operations Manager to oversee and optimize the day-to-day MES claims processing operations under the Fiscal Agent Operations function. This role involves managing the processing, adjudication, and resolution of healthcare claims for Medicaid beneficiaries while ensuring operational compliance and consistent service delivery.

As the Claims Operations Manager, you will lead a team responsible for ensuring that Medicaid claims processing operations meet performance standards, comply with state and federal regulations, and deliver a high degree of accuracy and timeliness.

Responsibilities

Manage and oversee day-to-day MES claims operations, ensuring timely and accurate processing, adjudication, and resolution of Medicaid claims according to guidelines and contractual Service Level Agreements (SLAs).
You will act as a thought partner to the leadership team to provide support and counsel for operations management, communications, initiatives and projects.
You should be a self-starter with outstanding organization and communication skills; fast-paced environment.
Understand strategic financials regarding areas of oversight.
Proven ability to build strong partnerships with colleagues, desire to be flexible and think proactively, strategically, and analytically about diverse business solutions and leading professional working groups.
Ability to make critical decisions with limited guidance while ensuring visibility into those decisions.
A demonstrated understanding of Medicaid support operations and an appreciation for how to prioritize among demands and balance the levers that make a complex business run smoothly and productively.
Manages Provider Enrollment operations for the program, including optimizing resources to facilitate SLA deliverables and maximize efficient operations.
Manages change management efforts and reporting to optimize SLAs and ensure optimization of resources.
Serve as lead cross departmental deliverables for operations, including internal and external audits, business continuity, and other program operations deliverables.
Serve as a resource for operational managers and assist with training and mentoring operational managers regarding key operational processes.
Lead cross departmental operational efforts for internal and external quality assessments, audits and surveys.
Lead cross departmental communication initiatives to both internal and external stakeholders, including community engagement efforts and efforts to facilitate employee engagement.
Manage and oversee key departments, including training and operational data efforts to optimize efficiencies and ensure effective operations.
Oversee and coordinate NCQA CVO efforts and all supporting efforts.
Manages and optimizes customer and key stakeholder relationships, including escalations and developing processes to facilitate timely management of provider enrollment related escalations.

Required Skills and Qualifications

Education: Bachelor's Degree in related technical, scientific, business, health or a related discipline
Required Experience: 5+ years of related experience
Required Skills and Abilities: Medicaid Operations Leadership Support , Project Management Skills, Provider Enrollment Management Skills and Experience, NCQA CVO knowledge and experience.
Demonstrated ability to communicate issues, impacts, and corrective actions
Preferred Skills: SharePoint, Excel, PMO, PowerPoint
Strong knowledge of Medicaid Fee-for-Service (FFS), and Managed Care claims processes.
Experience with healthcare claims software platforms and operational workflows.
Experience in claims repricing and interaction with national coding standards (e.g., CPT, ICD-10, HCPCS).

Preferred Qualifications

Familiarity with Program Integrity (PI) workflows, fraud/waste/abuse detection, and encounter data validation.
Proficiency with claims adjudication systems, reporting tools, and analytics platforms like Tableau or Power BI.
Familiarity with Medicaid Information Technology Architecture (MITA) and CMS certification processes.
Highly desirable certifications such as Certified Medical Reimbursement Specialist (CMRS) or lean process improvement certifications (e.g., Six Sigma).

Additional Information:

Work Arrangements: Hybrid, based in the Montgomery, AL area. Expect to be in office at least one day a week. Travel outside the area may be required.

Security: A background check will be required.

Timeline: This is a contingent job posting. Work is not expected to begin until AUGUST 2026 or later.

Work visa sponsorship will not be provided for this position.

GDIT IS YOUR PLACE
At GDIT, the mission is our purpose, and our people are at the center of everything we do.

Growth: AI-powered career tool that identifies career steps and learning opportunities
Support: An internal mobility team focused on helping you achieve your career goals
Rewards: Comprehensive benefits and wellness packages, 401K with company match, and competitive pay and paid time off
Flexibility: Full-flex work week to own your priorities at work and at home
Community: Award-winning culture of innovation and a military-friendly workplace

OWN YOUR OPPORTUNITY
Explore an enterprise IT career at GDIT and you’ll find endless opportunities to grow alongside colleagues who share your desire to drive operations forward.

Work Requirements

Years of Experience

5 + years of related experience

may vary based on technical training, certification(s), or degree

Certification

Travel Required

Less than 10%

Salary and Benefit Information

The likely salary range for this position is $111,155 - $150,385. This is not, however, a guarantee of compensation or salary. Rather, salary will be set based on experience, geographic location and possibly contractual requirements and could fall outside of this range.

Our Identity Verification Process

As part of the hiring process, we will ask you to complete an identity verification process that leverages advanced biometrics and artificial intelligence to ensure authenticity and protect against identity fraud. You are expected to be on camera during virtual interviews. We reserve the right to take your picture to verify your identity and prevent fraud. By proceeding, you authorize the collection, processing, and use of your biometric data for identity verification and security purposes.

About Our Work

We are GDIT. A global technology and professional services company that delivers technology solutions and mission services to every major agency across the U.S. government, defense and intelligence community. Our 26,000 experts extract the power of technology to create immediate value and deliver solutions at the edge of innovation. We operate across 50+ countries worldwide, offering leading mission-ready capabilities in AI, cloud, cyber and software development.

Join our Talent Community to stay up to date on our career opportunities and events at gdit.com/tc.

Equal Opportunity Employer / Individuals with Disabilities / Protected Veterans

Apply Now

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