Medicare Operations Manager

Job Title: Medicare Operations Manager

Location: Greater Chicago, IL

Job Description:

The Medicare Operations Manager oversees the day-to-day operations of Medicare programs, ensuring compliance with regulatory requirements, operational efficiency, and high-quality service delivery. This role manages teams responsible for enrollment, claims processing, provider services, and member support within Medicare Advantage or Medicare Supplement plans.

Key Responsibilities

• Manage operational processes related to Medicare Advantage, Part C, and Part D programs.
• Ensure compliance with regulations from the Centers for Medicare & Medicaid Services (CMS).
• Oversee teams handling claims processing, enrollment, eligibility, and member services.
• Monitor operational KPIs such as turnaround time, service level agreements (SLAs), and quality metrics.
• Coordinate with internal departments like compliance, IT, and provider network teams.
• Implement process improvements to enhance efficiency and reduce operational risks.
• Manage audits and ensure readiness for CMS or internal compliance reviews.
• Handle escalations related to Medicare member issues or provider concerns.
• Prepare operational reports and present insights to senior management.

Required Qualifications

• Bachelor’s degree in Healthcare Administration, Business Administration, or related field.
• 6–10 years of experience in healthcare operations or Medicare services.
• Strong understanding of Medicare Advantage, Part C, Part D regulations, and CMS guidelines.
• Experience managing teams in healthcare operations or insurance domain.
• Knowledge of healthcare claims systems and enrolment platforms.

Preferred Skills

• Experience with Medicare compliance and audits.
• Strong leadership and stakeholder management skills.
• Process improvement experience (Lean, Six Sigma preferred).
• Excellent analytical and reporting abilities.