Senior Manager Government Program Operations (Exchange)
New
J
Judi HealthHealth Technology
Remote or Hybrid (Local to Denver, CO, NYC area or Charlotte, NC)Full-TimeManager
Salary120,000 - 165,200 USD per year
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Job Details
- Experience
- 6+ years of relevant Prescription Benefit Management and/or Health Plan experience
- Required Skills
- Project ManagementData AnalysisCompliance
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/operational workflows.
- Demonstrated experience supporting regulatory reporting, audits, and compliance activities.
- Strong operational mindset with experience improving processes and driving execution.
- Ability to translate regulatory guidance into business and system requirements.
- Strong analytical skills and experience leveraging data to support decision-making.
- Proven success managing cross-functional teams and maintaining relationships with internal and external stakeholders.
- Excellent written and verbal communication skills.
- Highly organized with the ability to shift priorities easily in a fast-paced environment.
Responsibilities
- Lead Government Programs support for Exchange operations, including claims adjudication, regulatory reporting, and audit support.
- Oversee day-to-day operational performance for Exchange programs, ensuring alignment with contractual and regulatory requirements.
- Lead the interpretation, implementation, and monitoring of federal and state regulatory requirements.
- Collaborate cross-functionally with internal SMEs to assess regulatory impacts and ensure timely implementation of 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 and reporting.
- Support internal and external audits by federal and state agencies.
- Monitor operations to identify and resolve issues through root cause analysis and corrective actions.
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