Government Program Operations Manager – Analysis & Efficiencies in United States at Jobgether
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Job Description
This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Government Program Operations Manager – Analysis & Efficiencies based in the United States.
This role sits at the intersection of healthcare operations, regulatory compliance, and data-driven process optimization within government-sponsored healthcare programs. You will be responsible for ensuring Medicare, Medicaid, and Exchange operations are both fully compliant and highly efficient, with a strong focus on scalable systems and automation. The position blends analytical rigor with operational leadership, requiring someone who can interpret complex regulatory guidance and translate it into executable processes. You will lead initiatives that improve data accuracy, streamline workflows, and strengthen reporting and audit readiness across the organization. Working cross-functionally with compliance, product, client services, and technical teams, you will play a key role in shaping how government programs are administered at scale. This is a high-impact opportunity for a detail-oriented leader who thrives in complex, regulated environments and enjoys solving operational challenges through data and systems thinking.
- Interpret CMS and state regulatory guidance and translate requirements into operational processes in collaboration with compliance and subject matter experts
- Oversee implementation of regulatory changes, coordinating cross-functional teams to ensure timely and accurate execution across impacted systems and workflows
- Monitor government program operations to identify errors, perform root cause analysis, and implement corrective and preventative actions
- Support claims correction activities, including retro-eligibility adjustments and coordination of benefits (COB), ensuring accurate reprocessing of claims
- Lead efforts to support internal, client, and government audits by ensuring data integrity, documentation completeness, and process transparency
- Drive the development and maintenance of standardized documentation including workflows, policies, procedures, and reporting specifications
- Design and implement automated tools and scalable solutions to improve operational efficiency and data quality
- Analyze complex encounter and PDE data to identify trends, anomalies, and opportunities for process and performance improvement
- Define business and reporting requirements to support system enhancements and operational optimization initiatives
- Track and monitor key performance metrics for encounter and PDE submissions, ensuring alignment with regulatory and client expectations
- Foster subject matter expertise within the team by promoting knowledge sharing, continuous improvement, and operational consistency
- 5+ years of experience in healthcare data, operations, or analytics roles
- 5+ years of experience in PBM, health plan, Medicare Part D, Medicaid, or Exchange program environments
- Strong experience working with SQL, R, or Python for data analysis and reporting
- Demonstrated ability to manage multiple complex projects in a fast-paced, regulated environment
- Strong understanding of healthcare claims, encounter data, and government program operations
- Experience collaborating across cross-functional teams including compliance, operations, product, and client services
- Highly organized with strong attention to detail and ability to adapt to shifting priorities
- Excellent written and verbal communication skills, with the ability to translate complex data into clear insights
- Proven ability to contribute to process improvement, automation, and operational efficiency initiatives
- Strong problem-solving mindset with a focus on accuracy, scalability, and continuous improvement
- Competitive salary aligned with experience and location within the United States market
- Comprehensive medical, dental, and vision insurance coverage
- Flexible remote or hybrid work arrangements depending on location
- Opportunity to work on high-impact government healthcare programs that influence millions of members
- Exposure to advanced data systems, automation initiatives, and enterprise-scale operations
- Paid time off and standard company holidays
- Professional development opportunities in healthcare operations, analytics, and regulatory domains
- Collaborative, mission-driven environment focused on improving healthcare system efficiency.