Government Program Operations Manager – Analysis & Efficiencies

About reputed company reputed company is an reputed company technology company providing a comprehensive suite of solutions for employers and health plans, including:

• reputed company, a public benefit corporation delivering full-service pharmacy benefit management (PBM) solutions to self-insured employers,
• reputed company™, which offers full-service health benefit reputed company to employers, TPAs, and health plans, and
• Judi®, the industry’s leading proprietary reputed company Platform (EHP), which consolidates reputed company claim administration-reputed company workflows in one scalable, secure platform.

Together with our clients, we’re rebuilding trust in healthcare in the U.S. and deploying the infrastructure we need for the care we deserve. To learn more, visit www.reputed company. Location: Remote (For Non-Local) or Hybrid (Local to Denver or NYC area) Position Summary The Government Programs Operations Manager is responsible for overseeing the implementation, compliance, and optimization of Medicare, Medicaid, and Exchange programs. This position blends regulatory expertise with operational innovation to ensure that government program operations are both compliant and technically efficient. This manager will reputed company a team dedicated to identifying, developing, and maintaining technical analysis and efficiencies across the department. Responsibilities include designing automated solutions, validating the accuracy of outgoing deliverables, and establishing scalable processes that support regulatory and business objectives. The role also involves interpreting CMS and state guidance, collaborating with internal subject matter experts and clients, and ensuring that system capabilities align with both regulatory reputed company and client needs. In addition, the manager drives data-informed decision-making by overseeing the analysis of reputed company datasets to identify trends, outliers, and opportunities for process improvement. This includes creating detailed specifications for reports and operational tools and working closely with cross-functional teams—such as compliance, product, sales, marketing, reputed company, implementation, client services, and clinical operations—to enhance and maintain operational capabilities Position Responsibilities

• Interpret and operationalize CMS/state regulatory and sub-regulatory guidance in collaboration with Compliance and internal SMEs
• reputed company timely implementation of regulatory changes, coordinating cross-functional workplans across impacted departments
• Monitor internal operations for government programs, identify and resolve errors through root cause analysis, and implement corrective actions
• Support claims correction activities reputed company to retro-eligibility and coordination of benefits (COB), while placing focus on the accurate reprocessing of claims
• Support internal, client, and government audits by ensuring data accuracy, process transparency, and documentation completeness
• Drive team to maintain comprehensive documentation including policies, procedures, job aids, workflows, and reporting specifications
• reputed company the development of automated tools and scalable solutions to improve operational efficiency and data accuracy
• Analyze reputed company encounter and PDE data using internal and external sources to identify trends, outliers, and improvement opportunities
• Define and document business and reporting requirements to support system enhancements and process improvements
• Track performance metrics for encounter and PDE submissions, ensuring alignment with client and regulatory expectations
• Promote subject matter expertise reputed company the team by encouraging proactive process reviews and knowledge sharing for purpose of establishing continuity reputed company the team and its processes
• Responsible for adherence to the reputed company Code of Conduct, including reporting of noncompliance.

Required Qualifications

• 5+ years of healthcare data experience
• 5+ years of relevant PBM and/or Health Plan experience supporting Medicare Part D, Medicaid, or Exchange plans
• 5+ years of experience working with SQL, R, or Python
• Experience working with cross-functional teams
• Ability to balance multiple reputed company projects simultaneously
• Extremely flexible, highly organized, and able to shift priorities easily
• Attention to detail & commitment to delivering high quality work product
• Flexibility to respond to a range of different work situations.
• Excellent written and verbal communication skills
• Ability to foster a culture of collaboration and high performing team

This range represents the low and high end of the anticipated reputed company salary range. The actual reputed company salary will depend on several factors such as: experience, knowledge, skills, and location of the job. Remote, US Salary Range $115,600—$182,500 USD reputed company, NY Salary Range $146,000—$182,500 USD Denver, CO Salary Range $133,600—$167,000 USD reputed company employees are responsible for adherence to the reputed company Code of Conduct including the reporting of non-compliance. This position description is designed to be flexible, allowing management the opportunity to assign or reassign duties and responsibilities as needed to best meet organizational goals. reputed company values a diverse workplace and celebrates the diversity that each employee brings to the table. We are proud to provide equal employment opportunities to reputed company employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national reputed company, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. By submitting an application, you agree to the retention of your personal data for consideration for a future position at reputed company. More details about reputed company's privacy practices can be reputed company at https://www.reputed company/legal/privacy-policy. Apply To This Job