Program Manager, Ohio Claims

Elevance Health

. Manage Ohio Claims for the Medicaid line of business .

Posted 10/2/2026full-timeColumbus • Ohio • United StatesMid-LevelSenior💰 $92,720 - $139,080 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in managing Medicaid claims processes, ensuring compliance with regulatory requirements, and fostering external client relationships. Proficient in claims configuration, adjudication, and reporting, with a strong focus on program success metrics.

Highest-signal resume keywords

Medicaid Claims ManagementClaims ConfigurationRegulatory Reporting DevelopmentProgram/Project ManagementClient-Facing Experience

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims AdjudicationClaims PoliciesReimbursement PoliciesAuthorization CodesProgram Success MeasuresTimeliness ReportingAccuracy MonitoringBacklog ManagementProvider Payment ComplianceIndustry Trends Research

Soft Skills

CollaborationProblem SolvingCommunicationRelationship ManagementLeadership

Certifications & Qualifications

Project Management Certification

Industry Keywords

MedicaidDual ClaimsRegulatory ComplianceExternal Client-Facing ProgramsOhio Claims

About the role

Key responsibilities & impact

Manage Ohio Claims for the Medicaid line of business
Ensure resolution of claims configuration issues, rate changes, compliance, and contractual updates
Collaborate with claims teams, provider experience, utilization management, regulatory, and call center leads
Resolve issues involving claims policies, reimbursement policies, authorization codes, and provider complaints
Deliver regulatory claims reports on time, including Prompt Pay and Claims Disputes reports
Coordinate development, approval, implementation, and compliance of ongoing external client-facing programs
Research applicable subject-matter practices and monitor industry trends
Manage external client-facing relationships and partner with corporate and regional business areas
Develop program success measures and assess program success periodically
Oversee the end-to-end claims process, including receipt, adjudication, payment, and reporting on timeliness, accuracy, backlog, and provider payment compliance
Serve as operational liaison with the state of Ohio, Provider Experience, and internal executive leadership

Requirements

What you’ll need

Required to reside in Ohio
BA/BS required
Minimum of 5 years of external client-facing experience in program/project management
Any combination of education and experience providing an equivalent background may qualify
Strong understanding of Dual (Medicare and Medicaid) claims configuration and adjudication strongly preferred
Experience with regulatory reporting development, accuracy, and submission preferred
Graduate degree preferred
Project management certification preferred

Benefits

Comp & perks

Comprehensive benefits package
Incentive and recognition programs
Equity stock purchase
401k contribution
Merit increases
Paid holidays
Paid Time Off
Incentive bonus programs
Medical benefits
Dental benefits
Vision benefits
Short-term disability benefits
Long-term disability benefits
401(k) with match
Stock purchase plan
Life insurance
Wellness programs
Financial education resources
Hybrid work flexibility
COVID-19 and Influenza vaccination requirements for certain patient/member-facing roles