Manager Service Delivery (Remote in US)

Summary

The Manager, Service Delivery – CEF Center of Excellence serves as a key leader responsible for developing and executing strategies that drive operational excellence across Medicaid claims processing, including mailroom, data entry, and claims issue resolution workflows. This role ensures accurate, compliant, and timely claims processing aligned with CMS and state Medicaid requirements while optimizing efficiency, reducing rework, and improving provider and member experience.

Responsibilities

• Lead initiatives to optimize end-to-end claims lifecycle, including mailroom intake, data entry, reduce manual touches in claims adjudication and adjustment processing.
• Design and implement process standardization and best practices across institutional and professional claim streams.
• Develop and execute claims operations strategies to improve accuracy, turnaround time, and cost efficiency across Medicaid workflows.
• Analyze claims data, denial trends, and process steps to identify root causes, systemic issues, and opportunities for improvement.
• Define business and technical requirements to support mailroom and claims operations, systems, workflows, and compliance.
• Develop reporting frameworks, dashboards, and KPI structures to drive operational visibility and performance.
• Partner with product and engineering teams to ensure systems and data capture meet business and reporting needs.
• Support Design, Development and Implementation (DDI) efforts to ensure alignment with enterprise standards and data requirements.
• Drive continuous improvement initiatives using data analytics, process improvement methodologies, and automation opportunities.
• Establish and maintain operational playbooks and governance structures for claims processing and issue management.

Requirements

• Five (5) or more years of experience in Medicaid operations, claims management, mailroom intake operations, or business analysis.
• Strong analytical and problem-solving skills with the ability to interpret claims data, identify trends, and drive actionable insights, and experience with data and reporting tools (e.g., Excel, Power BI).
• Proven ability to lead cross-functional initiatives across operations, compliance, and IT in a healthcare payer environment.
• Strong knowledge of Medicaid claims processing, CMS guidelines, and coordination of benefits workflows.
• Excellent communication and stakeholder management skills, with experience influencing senior leadership and external partners.

Qualifications

• Master’s degree in Healthcare Administration, Business Administration, Information Technology, or a related field.
• Professional certifications such as Certified Medicaid Claims Professional (CMCP), Certified Medical Billing Professional (CMBP), or similar.

Benefits

• Generous, flexible vacation policy.
• Company match 401(k).
• Comprehensive health benefits.
• Educational assistance.

Pay

The pay range for this position is $86,700.00 - $123,900.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors.