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NEOGOV · 10 hours ago

Medicaid Claims Manager

Salt Lake County, UT

Full-time

Hybrid

Mid, Senior Level

$28.16/hr - $47.18/hr

NEOGOV is part of the Utah Department of Health and Human Services, and they are seeking a Medicaid Claims Manager to join their Office of Medicaid Operations. This role involves advanced programming experience with SQL and relational databases, focusing on claims processing and data analysis to support departmental needs and policy development.

GovTechHuman ResourcesInformation TechnologySoftware

Responsibilities

Develop, write, and execute complex SQL queries, including the use of joins, subqueries, aggregates, and functions, to extract and manipulate data from the Data Warehouse and other relevant systems (e.g., PRISM claims system)

Extract and prepare data to support various departmental needs, including examining trends, evaluating claims processing, conducting program evaluations, and informing policy development

Perform statistical and/or actuarial analysis by applying appropriate protocols to analyze data and draw accurate conclusions

Analyze, summarize, and review data to report findings, interpret results, and/or make recommendations for management

Act as a subject matter expert and technical resource for management and staff on data availability, structure, and extraction methods

Resolve difficult and unusual data problems, leveraging expert knowledge and experience with interfacing automated data systems

Review data production for potential issues and propose solutions, enhancements, and procedural changes to improve data quality and efficiency

Write or draft technical reports, articles, or related materials based on in-depth research, investigation, and data analysis

Meet and confer with management, end-users, and external contract providers to understand data needs, resolve problems, and coordinate services

Ensure all data access and handling practices adhere to strict confidentiality policies, especially when dealing with sensitive information like applicant or recipient data, as mandated by Medicaid/DHHS policy

Qualification

SQLData AnalysisData QualityRegulatory ComplianceData EngineeringAnalytical Data ModelingLegacy System ConversionPolicy InterpretationStakeholder PartnershipIndependent WorkCritical Thinking

Required

Advanced programming experience with SQL and relational databases

Critical thinking skills

Experience with claims processing and data analysis

Proven ability to architect and implement production-ready data solutions and data transformation routines using advanced SQL

Experience designing and building reliable analytical data models to deliver high-quality, trusted datasets for stakeholders and leadership

Skill in reverse-engineering and translating complex business logic from legacy End-User Computing (EUC) tools into stable, version-controlled code

Experience implementing automated data quality checks, monitoring, and validation processes to ensure solution accuracy and reliability

Strong understanding of data security principles and experience designing systems that ensure technical compliance with HIPAA, CMS, and state data governance policies when handling Protected Health Information (PHI) and PII

Ability to read, interpret, and accurately apply state and federal laws, rules, regulations, and policies related to the Medicaid/Medicare system

Excellent written and verbal communication skills

Ability to plan, organize, and prioritize workload, meet deadlines, and work independently

Critical thinking skills

Preferred

Experience with healthcare claims processing and data analysis

Benefits

On-site fitness center, for a minimal membership fee

UTA Eco Pass, at a discounted monthly rate

Teleworking opportunities with a minimum 2 office days

On-site day care center at the Cannon Health Building with First Steps Day Care - contact for rates and availability, 385-382-4012 or firststepschildcareslc@gmail.com

The State of Utah offers eligible employees a variety of benefits including medical, dental, life and disability insurance, as well as a comprehensive leave program.