Sr Medicaid Subject Matter Expert - CMS-64 - Federal Reporting and Policy - Remote

Job ID: 102904276032Posted: 2026-11-06Location: Schaumburg, Illinois, United StatesSalary: $112,700 - $193,200/yearJob Area: Business & Data AnalyticsCompany: UnitedHealth GroupOptum Insight is improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, and ultimately consumers. Our deep expertise in the industry and innovative technology empower us to help organizations reduce costs while improving risk management, quality and revenue growth. Ready to help us deliver results that improve lives? Join us in making healthcare work better for everyone through people-led, responsible AI while Caring. Connecting. Growing together.Position SummaryThis senior Medicaid SME supports the State Medicaid Agency Enterprise Data Warehouse (EDW). The role is the business and policy anchor for Medicaid data and federal reporting, with a primary focus on CMS-64 and related financial and federal reporting. The person in this role understands not only what the data says, but why the business works the way it does: the Medicaid policy, program rules, and federal requirements behind each claim, eligibility record, and report line.This SME will work alongside the existing Medicaid SME and data specialist team to build depth and continuity across Medicaid policy, federal reporting, and EDW data. The role brings credibility with State program, finance, and executive staff, and will regularly brief senior leadership up to the Agency Director level.You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week.Primary Responsibilities:Serve as a senior Medicaid business and policy SME for the IL EDW, guiding State and Optum teams on claims, eligibility, provider, managed care/encounter, TPL, and financial data and how they relate to Medicaid program rulesLead the business side of CMS-64 reporting support, including understanding expenditure categories, FMAP and enhanced match rules, reporting periods, prior period adjustments, and reconciliation of EDW data to State financial submissionsSupport other federal reporting work such as MARS, T-MSIS, PERM, and CMS Core Set/Quality of Care measures, making sure reports tie back to source data and federal guidanceInterpret federal and State policy (CMS guidance, SMD/SHO letters, the State Medicaid Manual, the State Plan and waivers, and State administrative rules) and translate it into clear business rules, requirements, and acceptance criteriaExplain the "why" behind the numbers Help State users and leadership understand trends, variances, and data issues in plain business terms, along with the policy or operational drivers behind themPrepare and deliver executive briefings, issue summaries, and recommendations to Optum leadership and State senior leadership, including Bureau Chiefs, Deputy Administrators, and the Agency DirectorWork with State finance and program teams (including the Bureau of Fiscal Operations), MCO partners, and other vendors on joint reporting timelines, dependencies, and approvalsReview and validate report logic, data mappings, and test results from a business and policy standpoint before deliverables go to the State or CMSIdentify data quality and reporting risks early, and recommend practical options to resolve themMentor analysts, developers, and data specialists on Medicaid business knowledge, and help build documented knowledge and backup coverage so no single person is a point of failureStay current on federal and State Medicaid changes (CMS rules, legislative mandates, federal reporting system changes) and advise the team and the State on impacts to the EDW and reportingYou'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications:15+ years of healthcare experience, including 10+ years working directly with or for State Medicaid agencies, MMIS/MES vendors, or Medicaid data warehouse/decision support programs3+ years of experience with other federal CMS reporting such as MARS, T-MSIS, PERM, or CMS Core Set measuresHands-on experience supporting CMS-64 reporting, including expenditure reporting, FMAP/enhanced match, claiming categories, and reconciliation of data to financial reportsSolid working knowledge of Medicaid and CHIP policy and program rules, including eligibility groups, benefits and covered services, managed care, waivers, TPL, and claims adjudicationDeep understanding of Medicaid data (claims, encounters, eligibility, provider, financial) and how it flows from source systems into a data warehouse and federal reportsProven ability to present to and advise senior executives, including State agency directors or equivalent, with clear and concise briefingsProven ability to translate policy and federal guidance into business rules and requirements that technical teams can build and testProven working ability to query and validate data using SQL or similar tools against large datasetsProven ability to travel to Springfield, IL three (3) to four (4) times per year or as neededProven excellent written and verbal communication, sound judgment, and the ability to stay calm and credible in high-visibility, deadline-driven situationsNote: Core customer business hours are M-F 8 AM to 5 PM CSTPreferred Qualifications:Experience with State Medicaid finance operations, CMS-64 quarterly cycles, CMS-37 budget reporting, or federal draw and claiming processesExperience supporting MMIS/MES CMS certification, audits, or federal reviewsProduct owner or lead SME experience for a federal reporting module or Medicaid DSS/data warehouseExperience with Illinois Medicaid programs, or Medicaid managed careExperience with Teradata, Business Objects, Tableau, Power BI, or similar reporting and data toolsExperience using Azure DevOps, JIRA, or similar tools, and SharePoint for documentation and collaborationFamiliarity with CMS federal financial reporting systems (MBES/CBES) and the transition to MACFinLocated within driving distance of Springfield, IL*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter PolicyPay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $112,700 - $193,200 annually based on full-time employment. We comply with all minimum wage laws as applicable.Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.At UnitedHealth Group, our mission is to help people live healthier lives and help make the health system work better for everyone. Together, we are shaping the future of healthcare by harnessing technology and innovation to make care simpler to navigate, more affordable and more connected for the people we serve. We are committed to creating an inclusive workplace where everyone feels welcomed, valued, heard and respected, empowering people to bring their authentic selves to work and strengthening our collective impact through diverse talents, backgrounds, experiences and perspectives.UnitedHealth Group and its affiliated brands are an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.UnitedHealth Group and its affiliated brands are a drug-free workplace. Candidates are required to pass a drug test before beginning employment.