Program Manager- Ohio Claims

Elevance Health•Columbus, OH

1d•Hybrid

About The Position

The Program Manager will be responsible for Ohio Claims for Medicaid line of business, ensuring resolution to claims configuration issues, rate changes, compliance and contractual updates. Program managers typically support business strategies through an integrated portfolio of external client facing projects or initiatives. A program manager may have responsibility for a piece of a larger enterprise/regional external client facing program. This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace.

Requirements

Requires a BA/BS and minimum of 5 years external client facing experience in program/project management; or any combination of education and experience, which would provide an equivalent background.

Nice To Haves

Graduate degree preferred.
Project management certification preferred.
Strong understanding of Dual (Medicare and Medicaid) claims configuration & adjudication is strongly preferred.
Experience with regulatory reporting development, accuracy, and submission preferred.

Responsibilities

Work collaboratively with claims teams, provider experience, utilization management, regulatory and call center leads to resolve issues and concerns as they relate to claims policies, reimbursement policies, codes requiring authorizations, and provider complaints.
Accountable for on time delivery of regulatory reports related to claims (i.e. Prompt Pay, Claims Disputes and others).
Manages and coordinates the development, approval, implementation and compliance of on-going external client facing programs.
Researches applicable subject matter practices and remains aware of industry trends.
Manages external client facing relationships and partners with corporate and regional business areas.
Develops program success measures and performs periodic assessments of program success.
Oversee the end-to-end claims process, including receipt, adjudication, payment, and performance reporting on claims timeliness, accuracy, backlog and provider payment compliance.
Serve as the operational liaison with the state of Ohio, Provider Experience, and internal executive leadership.