Medicaid Project Manager

TEKsystems•Honolulu, HI

2d•$40 - $58•Hybrid

About The Position

TEKsystems is supporting a leading healthcare payer seeking a Medicaid Project Manager to lead end-to-end operational and process transformation initiatives within its Medicaid line of business. This role is responsible for optimizing claims and operational workflows, improving vendor performance, and enhancing data visibility through effective reporting and dashboards. The ideal candidate will bring strong Medicaid and claims expertise, a process improvement mindset, and the ability to translate operational data into actionable insights that drive performance and continuous improvement across the Medicaid lifecycle.

Requirements

Experience in healthcare payer operations, with Medicaid experience strongly preferred
Strong understanding of claims processing and operational workflows, including 837 transactions
Experience leading cross-functional programs or transformation initiatives
Demonstrated ability to redesign processes, identify gaps, and drive operational improvements
Experience working with reporting, dashboards, or data-driven performance management
Ability to understand system architecture and data flow across multiple platforms

Nice To Haves

Knowledge of Medicaid regulations and compliance requirements
Experience working in complex or legacy system environments
Exposure to vendor management and SLA-based performance tracking

Responsibilities

Lead initiatives to restructure and optimize end-to-end Medicaid operational workflows, from intake through adjudication and downstream processes
Identify workflow inconsistencies, operational gaps, and inefficiencies, and design scalable, sustainable solutions
Drive continuous improvement efforts to reduce manual work, improve processing timelines, and enhance quality outcomes
Support and oversee 837 transaction processing and the full claims lifecycle
Analyze breakdowns across claims workflows to improve accuracy and reduce rework
Partner with Medicaid encounters, IT, data, and operational teams to improve system integration, mapping, and data integrity
Define KPIs and reporting requirements to measure operational performance, workflow efficiency, and error rates
Partner with analytics and IT teams to design and enhance dashboards that provide actionable operational insights
Evaluate existing reporting structures and improve visibility, accuracy, and timeliness
Translate business needs into reporting and data solutions that support proactive decision-making
Develop a strong understanding of systems, tools, and data sources supporting Medicaid operations
Identify gaps in system monitoring and establish strategies to improve end-to-end visibility
Collaborate with IT and business teams to enhance system-level tracking, alerts, and reporting capabilities
Enable early identification of issues and operational bottlenecks through improved transparency
Establish mechanisms to identify, track, and manage errors across end-to-end processes
Implement structured root cause analysis and long-term remediation approaches
Monitor trends to prevent recurring issues and improve operational outcomes
Support oversight of vendors supporting Medicaid operations
Monitor vendor performance through data-driven metrics and SLA tracking
Drive accountability and continuous improvement with vendor partners
Collaborate cross-functionally with operations, IT, compliance, data, and vendor teams
Facilitate working sessions to identify process, system, and reporting improvements
Communicate insights, risks, and performance trends to leadership using clear, data-driven storytelling