{"id":1623124,"url":"https://alion.io/job/conduent-operations-claims-processing-manager","title":"Operations Claims Processing Manager","company":{"id":1772445,"name":"Conduent","domain":"conduent.com","url":"https://alion.io/company/conduent-com","size_band":"1001-5000","is_staffing_agency":false,"employer_type":"direct","is_intermediary":false,"listed_via":null,"ats_vendor":"Oracle","truth_index":{"grade":"B","score":76,"open_postings":47,"ghost_share":0,"stale_share":0.957,"repost_share":0,"time_to_fill_p50_days":29,"computed_at":"2026-11-03T05:54:40Z"}},"role":"Operations","role_family":"Operations","seniority":"senior","employment_type":null,"work_mode":"on_site","remote_scope":null,"remote_scope_basis":null,"remote_working_hours":null,"hiring_geo_confidence":"structured","locations":["Montgomery, United States"],"countries":["US"],"hiring_countries":[],"hiring_countries_total":0,"salary":{"min":77770,"max":101000,"currency":"USD","period":"year","gross":null,"usd_annual":101000},"salary_estimate":null,"experience_years_min":8,"visa_sponsorship":false,"relocation_package":false,"has_equity":false,"technologies":[],"status":"live","first_seen_at":"2026-07-21T19:14:39Z","employer_posted_date":"2026-07-21","last_verified_at":"2026-11-04T00:40:39Z","board_verified":true,"closed_at":null,"days_open":105,"trust":{"level":"stale","repost_count":0,"flags":["stale"],"days_open":104},"description":"The Operations Claims Processing Manager is responsible for leading all Medicaid Claims Processing operations and serves as the primary point of contact for claim-related operational functions. This role provides leadership and oversight for Claims Resolution, Drug Rebate activities, Medical Policy, Financial Transactions, and Data Entry operations.\nThe ideal candidate is an experienced Medicaid operations leader with a strong background in claims processing, regulatory compliance, performance management, and operational excellence. This individual will drive process improvements, ensure SLA and KPI achievement, and maintain compliance with CMS regulations and Medicaid State Plan requirements.\nThis position is contingent upon the award of a government contract. Recruiting and interviewing activities may occur prior to contract award; however, employment and start dates are subject to contract award, funding, customer approval requirements, and/or satisfaction of any applicable pre-employment conditions.\nKey Responsibilities\nServe as the primary point of contact for all Medicaid Claims Processing operations.\nManage and oversee Claims Resolution, Drug Rebate operations, Medical Policy, Financial Transactions, and Data Entry functions.\nDefine, implement, and maintain operational policies and procedures.\nIdentify opportunities for operational improvement and drive process enhancement initiatives.\nLead, coach, and develop claims processing teams and operational staff.\nEnsure adherence to established operational processes, policies, and compliance requirements.\nMonitor and manage operational tools and systems to support efficient claims processing.\nOwn and drive achievement of operational Service Level Agreements (SLAs) and Key Performance Indicators (KPIs).\nAnalyze operational performance metrics and produce reports for leadership and stakeholders.\nServe as the primary point of contact regarding CMS regulations, Medicaid policies, and State Plan requirements.\nPartner with internal and external stakeholders to ensure accurate and timely claims processing.\nManage escalated operational issues and implement corrective actions as needed.\nRequired Qualifications\nBachelor's degree in Computer Science, Information Systems, Healthcare Administration, Business Administration, or a related field; or equivalent combination of education and experience.\nMinimum of eight (8) years of experience managing Medicaid claims processing operations or major healthcare payer claims operations.\nDemonstrated experience leading claims processing teams and complex operational functions.\nStrong knowledge of Medicaid claims processing, reimbursement methodologies, and healthcare operations.\nExperience managing operational metrics, SLA performance, and KPI reporting.\nExcellent written, verbal, and presentation communication skills.\nStrong analytical, organizational, and problem-solving abilities.\nAbility to thrive in a fast-paced, high-volume, and high-pressure environment.\nMust complete a background check that includes fingerprinting.\nPreferred Qualifications\nExperience supporting Medicaid programs or government healthcare contracts.\nKnowledge of CMS regulations, Medicaid policy, and state healthcare requirements.\nExperience with claims adjudication, provider reimbursement, and financial transaction operations.\nProven track record of implementing operational improvements that increase efficiency and quality.\nExperience presenting operational results to executive leadership and government agency stakeholders.\nFlexible Working\nAt Conduent, we want you to be yourself. We recognize that everyone is different and that how people want to work and deliver at their best is different for everyone too.\nIn this role, you can expect the following working conditions:\nOnsite work: Work in our local office, receiving personal coaching and leadership so that you can provide the best support to our clients and help you grow in your career.\n\nWorking For You\nPerks and rewards designed for you:\nHealth and Welfare Benefits: Our health and welfare benefits can be tailored to fit you and your family's needs and start on the first day of employment.\n\nRetirement Savings: We will support you as you save for your future.\n\nEmployee Discounts: We offer you access to a vast selection of global, national, and local discounts on merchandise, services, travel, and more.\n\nCareer Growth Opportunities: We help you thrive, so together, we can grow. We provide opportunities to advance your career with a vast portfolio of businesses and a global footprint.\n\nPaid Training: Earn while you learn and continue to grow with access to award-winning learning platforms throughout your Conduent career.\n\nPaid time off: We provide attractive paid time off packages designed for you to enjoy your life away from work.\n\nGreat Work Environment: We are proud of our award-winning culture and the recognition we’ve received for our diversity efforts.\n\nJoin Us\nAt Conduent, we are one team, one mission. We understand that our success is directly related to the success of our associates.\nWe strive to create a culture where you can:\nBring your authentic self to work.\n\nGrow and thrive, both personally and professionally.\n\nMake a difference with our clients, in our communities, and with the millions of people we support.\n\nPay Transparency Laws in some locations require disclosure of compensation and/or benefits-related information. For this position, actual salaries will vary and may be above or below the range based on various factors including but not limited to location, experience, and performance. In addition to base pay, this position, based on business need, may be eligible for a bonus or incentive. In addition, Conduent provides a variety of benefits to employees including health insurance coverage, voluntary dental and vision programs, life and disability insurance, a retirement savings plan, paid holidays, and paid time off (PTO) or vacation and/or sick time. 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