Operations Manager, Medicaid Account Management - Columbia, SC
About The Position
The Operations Manager, Medicaid Account Management will be responsible for account activities such as: MAC management, provider relations, call center escalations, web portal updates, user acceptance testing, coordination with client pharmacy operations staff, standard and custom report development, and data analytics. The position will report to the Associate Director, Medicaid Account Management on the account team. Position is expected to start in January 2027. If you are located in Columbia, SC, you will have the flexibility to work remotely as you take on some tough challenges.
Requirements
- 2+ years of experience supporting a State Medicaid account
- Experience using healthcare claims processing systems and reporting tools
- Experience collaborating with cross-functional internal business partners to deliver contract requirements, support special projects, and resolve operational issues
- Demonstrated knowledge of Medicaid systems, benefits administration, reporting and analytics, and call center escalation processes
- Proficiency with Microsoft Office applications, including Word, Excel, PowerPoint, and Outlook
- Proven ability to lead and facilitate meetings in both in-person and virtual environments, including presentations via Microsoft Teams
- Proven track record of driving client satisfaction and client retention
- Ability to work at the client location in Columbia, SC 25%25-50%25 of the time
Nice To Haves
- Certified Pharmacy Technician (CPhT) certification and active pharmacy technician license
- Experience with Optum Rx claims processing platform (RxClaim)
- Experience with Optum Rx reporting and analytics platform (RxTrack)
Responsibilities
- Use industry knowledge to add value to the clients’ operations and look for up sell opportunities
- Maintain an ongoing knowledge of clients’ business; as well as their contract with Optum
- Provide leadership for new client projects / implementations
- Provide regular communication to management on client concerns and feedback
- Communicate with clients via face - to - face meetings, conference calls and written correspondence
- Interfaces with internal Optum departments
- Maintain client business rules and implement them in the Optum systems
- Understands the eligibility and pharmacy claims adjudication process
- Monitor performance guarantees / Service Level Agreements
- Maintain rates such as State MAC, 340b, and other customer State rates
- Conduct periodic reviews with client and recommend new products / services as appropriate
- Contribute to client satisfaction, retention and growth
- Functions in a dedicated on-site service capacity
Benefits
- comprehensive benefits package
- incentive and recognition programs
- equity stock purchase
- 401k contribution
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What This Job Offers
Job Type
Full-time
Career Level
Manager
Education Level
No Education Listed
