Medicaid Project Manager

Medicaid Project Manager

Location: Hawaii (Hybrid)

Work Schedule: Hybrid (2-3 days onsite; flexibility)

Job Type: Contract

Base

Location:

Honolulu, HI

TEKsystems is supporting a leading healthcare payer seeking a Medicaid Project Manager to lead end-to-end operational and process transformation initiatives within its Medicaid line of business. This role is responsible for optimizing claims and operational workflows, improving vendor performance, and enhancing data visibility through effective reporting and dashboards. The ideal candidate will bring strong Medicaid and claims expertise, a process improvement mindset, and the ability to translate operational data into actionable insights that drive performance and continuous improvement across the Medicaid lifecycle.

• Lead initiatives to restructure and optimize end-to-end Medicaid operational workflows, from intake through adjudication and downstream processes
• Identify workflow inconsistencies, operational gaps, and inefficiencies, and design scalable, sustainable solutions
• Drive continuous improvement efforts to reduce manual work, improve processing timelines, and enhance quality outcomes

• Support and oversee 837 transaction processing and the full claims lifecycle
• Analyze breakdowns across claims workflows to improve accuracy and reduce rework
• Partner with Medicaid encounters, IT, data, and operational teams to improve system integration, mapping, and data integrity

• Define KPIs and reporting requirements to measure operational performance, workflow efficiency, and error rates
• Partner with analytics and IT teams to design and enhance dashboards that provide actionable operational insights
• Evaluate existing reporting structures and improve visibility, accuracy, and timeliness
• Translate business needs into reporting and data solutions that support proactive decision-making

• Develop a strong understanding of systems, tools, and data sources supporting Medicaid operations
• Identify gaps in system monitoring and establish strategies to improve end-to-end visibility
• Collaborate with IT and business teams to enhance system-level tracking, alerts, and reporting capabilities
• Enable early identification of issues and operational bottlenecks through improved transparency

• Establish mechanisms to identify, track, and manage errors across end-to-end processes
• Implement structured root cause analysis and long-term remediation approaches
• Monitor trends to prevent recurring issues and improve operational outcomes

• Support oversight of vendors supporting Medicaid operations
• Monitor vendor performance through data-driven metrics and SLA tracking
• Drive accountability and continuous improvement with vendor partners

• Collaborate cross-functionally with operations, IT, compliance, data, and vendor teams
• Facilitate working sessions to identify process, system, and reporting improvements
• Communicate insights, risks, and performance trends to leadership using clear, data-driven storytelling

• Experience in healthcare payer operations, with Medicaid experience strongly preferred
• Strong understanding of claims processing and operational workflows, including 837 transactions
• Experience leading cross-functional programs or transformation initiatives
• Demonstrated ability to redesign processes, identify gaps, and drive operational improvements
• Experience working with reporting, dashboards, or data-driven performance management
• Ability to understand system architecture and data flow across multiple platforms

• Knowledge of Medicaid regulations and compliance requirements
• Experience working in complex or legacy system environments
• Exposure to vendor management and SLA-based performance tracking

• Opportunity to modernize and improve long-standing Medicaid operational processes
• High visibility role with direct impact on efficiency, quality, and outcomes
• Collaborative environment working across operations, IT, data, and leadership
• Hybrid work environment with flexibility

The pay range for this position is $40.00 - $58.00/hr.

• Medical, dental & vision
• Critical Illness, Accident, and Hospital
• 401(k) Retirement Plan - Pre-tax and Roth post-tax contributions available
• Life Insurance (Voluntary Life & AD&D for the employee and dependents)
• Short and long-term disability
• Health Spending Account (HSA)
• Transportation benefits
• Employee Assistance Program
• Time Off/Leave (PTO, Vacation or Sick Leave)

The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

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