Senior Manager Government Program Operations (Exchange)
New
J
Judi HealthHealth Technology
Remote (For Non-Local) or Hybrid (Local to Denver or NYC area)Full-TimeManager
Salary120,000 - 135,000 USD per year
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Job Details
- Experience
- 6+ years of relevant Prescription Benefit Management and/or Health Plan experience; 5+ years people management experience
- Required Skills
- Data AnalysisPeople ManagementCross-functional Team LeadershipProcess improvement
Requirements
- 6+ years of relevant Prescription Benefit Management and/or Health Plan experience supporting Exchange programs
- 5+ years people management experience
- Subject matter expertise of Exchange regulatory requirements and associated product and/or operational workflows
- Demonstrated experience supporting regulatory reporting, audits, and compliance activities
- Ability to translate regulatory guidance into business and system requirements
- Proven success managing cross functional teams and maintaining effective relationships at all levels both internal and external; including government entities
- Strong operational mindset with experience improving processes and driving execution
- Strong analytical skills and experience leveraging data to support decision-making
- Extremely flexible, highly organized, and able to shift priorities in a fast-paced environment
- Excellent written and verbal communication skills
- Attention to detail & commitment to delivering high quality work product
Responsibilities
- Lead Government Programs support for Exchange operations, including claims adjudication, regulatory reporting, and audit support (Government and Client)
- Oversee day-to-day operational performance for Exchange programs, ensuring alignment with contractual, regulatory requirements, and client expectations
- Lead the interpretation, implementation, and monitoring of federal and state regulatory requirements impacting Exchange lines of business
- Collaborate cross-functionally with SMEs (Claims, Product, Technology, Compliance, Legal) to assess regulatory impacts and ensure timely, coordinated implementation of required changes
- Design, document, and scale operational processes that enable accurate, compliant, and efficient service delivery
- Define business and system requirements to support compliant claims processing, data accuracy, and reporting outcomes
- Lead regulatory reporting activities and ensure completeness, accuracy, and timeliness of all required submissions
- Support internal and external audits by federal and state agencies, including audit preparation, documentation, issue response, and remediation tracking
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