Health Insurance Specialist

Job Title

Job Description

Help

Developing and evaluating Medicaid Managed Care policies by researching statutory requirements, program history, and policy options to support effective program administration and beneficiary services.

Analyzing proposed legislation, regulations, and policy initiatives to determine impacts on Medicaid Managed Care programs and recommending changes to improve program effectiveness and operations.

Reviewing state reports, compliance documentation, and managed care policies to assess adherence to federal requirements and verify completion of corrective and enforcement actions.

Conducting analytical studies of Medicaid policies, procedures, guidance, business processes, and systems to identify operational problems and recommend improvements in efficiency and effectiveness.

Preparing briefing materials, reports, issue papers, and program guidance and communicating Medicaid Managed Care policies, requirements, and operational issues to internal and external stakeholders.

Coordinating Medicaid program assignments and projects with internal staff, states, contractors, and health care organizations to resolve issues, develop solutions, and support division priorities.