Texas Medicaid Operations Specialist

Health Care Service Corporation

. Provide operational services, assistance, and program implementation and coordination for Medicaid operational functions .

Posted 9/23/2026full-timeRichardson • Texas • United StatesMid-LevelSenior💰 $55,900 - $123,500 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in Medicaid operational functions, including compliance, reporting, and program implementation. Proficient in managing multiple projects and utilizing data analysis to enhance operational performance and support decision-making.

Highest-signal resume keywords

Medicaid Operational FunctionsProject ManagementData AnalysisTexas Medicaid ComplianceUtilization Management

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Project DevelopmentOperational Performance MonitoringData ReportingCompliance ManagementContract Provisions ManagementBusiness Process ImplementationAdvanced Microsoft ExcelPower BICare Management OperationsTexas Medicaid Requirements

Soft Skills

Verbal CommunicationWritten CommunicationInterpersonal SkillsOrganizational SkillsAnalytical Skills

Industry Keywords

Texas MedicaidCHIPUniform Managed Care ManualManaged Care ContractsHealth Insurance Operations

About the role

Key responsibilities & impact

Provide operational services, assistance, and program implementation and coordination for Medicaid operational functions
Support Utilization Management, Care Management, reporting, compliance, billing, claims, enrollment, and customer service operations
Resolve complex and/or escalated internal or external operational questions
Work with other organizational areas to develop, test, and implement program policies, business processes, reporting solutions, and system changes
Ensure Texas Medicaid plan state requirements are met
Interpret and support requirements in the Texas Medicaid and CHIP Uniform Managed Care Manual and applicable managed care contracts
Use data and reporting to monitor operational performance, identify gaps, and support compliance
Represent the Medicaid department at committee meetings
Coordinate corrective actions or operational improvements

Requirements

What you’ll need

Bachelor Degree in Business with 4 years’ experience OR 8 years of experience working in health insurance operations
Experience in project development, implementation and execution skills
Experience interfacing with internal clients and operations personnel
Verbal and written communication skills
Ability to represent Medicaid department at committee meetings
Experience interacting effectively with all levels of internal and external customers
Experience managing multiple projects effectively
Interpersonal, organizational and analytical skills
Organizational and leadership skills
Sponsorship is not available
Preferred: Experience managing contract provisions
Preferred: Experience in Project Management
Preferred: Direct experience supporting Texas Medicaid managed care operations
Preferred: Working knowledge of the Texas Medicaid and CHIP Uniform Managed Care Manual (UMCM) and Uniform Managed Care Contract (UMCC) requirements
Preferred: Experience interpreting or applying UMCM requirements to operational processes, reporting, deliverables, or compliance activities
Preferred: Hands-on experience with Texas Medicaid Utilization Management (UM) and/or Care Management (CM) operations
Preferred: Experience interpreting Texas Medicaid managed care contract requirements
Preferred: Experience monitoring operational performance or compliance, identifying gaps, validating deliverables/data, and coordinating corrective actions or operational improvements
Preferred: Strong reporting and data-analysis skills, including advanced Microsoft Excel
Preferred: Power BI/dashboard development or reporting experience
Preferred: Ability to analyze complex Medicaid operational requirements and translate them into clear business requirements, processes, reporting, and actionable recommendations

Benefits

Comp & perks

Professional development plans
Health and wellness benefits
401(k) savings plan
Pension plan
Paid time off
Paid parental leave
Disability insurance
Supplemental life insurance
Employee assistance program
Paid holidays
Tuition reimbursement
Annual incentive bonus plan
Other incentives