Claims Manager – Maryland Medicaid

The Manager of Claims Management is responsible for overseeing Medicaid claims operations, inventory management, quality assurance, and compliance monitoring. This role ensures timely and accurate processing of Medicaid claims in accordance with state and federal regulations, contractual requirements, and organizational performance standards. The manager partners cross-functionally with Provider Relations, Configuration, Compliance, Finance, Appeals and Grievance. and Medical Management. **Key Responsibilities** CMS requirements and Federal managed care rules

Timely filing laws and encounter data reporting requirements**Required Qualifications** Bachelor’s degree in Business, Healthcare Administration, or related field (or equivalent experience).3–5+ years of progressive claims experience in Medicaid.Experience with major claims systems (e.g., QNXT).Problem solving mindset; adaptable, ability to analyze processes.

Proven ability to drive performance and optimize operational workflows.Analytical skills with proficiency in Excel and claims data analysis.Job responsibilities are not limited to the description above.

**Preferred Qualifications** Experience with Medicaid managed care organizations (MCOs) or state Medicaid agencies. Knowledge of fee schedules, and Medicaid pricing methodologies. * **Affordable medical plan options,** a **401(k) plan** (including matching company contributions), and an **employee stock purchase plan**.* **No-cost programs for all colleagues** including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.* **Benefit solutions that address the different needs and preferences of our colleagues** including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. #J-18808-Ljbffr