Texas Medicaid Operations Specialist (Medicaid)

Location: Richardson, Texas headquarters; hybrid schedule with 3 days in the office and 2 days remote

Base pay: $55,900–$123,500 annually

Company

hirify.global is a purpose-driven health insurance organization focused on supporting members and investing in employee development.

What you will do

• Provide operational services, assistance, and program coordination across Medicaid functions including utilization management, care management, reporting, compliance, billing, claims, enrollment, and customer service.
• Resolve complex and escalated operational questions from internal and external stakeholders.
• Support the development, testing, and implementation of policies, business processes, reporting solutions, and system changes.
• Interpret and apply Texas Medicaid and CHIP Uniform Managed Care Manual and managed care contract requirements.
• Use data and reporting to monitor operational performance, identify gaps, validate deliverables, and support compliance.
• Coordinate operational improvements and corrective actions with internal teams.

Requirements

• Bachelor’s degree in business with 4 years of relevant experience, or 8 years of experience in health insurance operations.
• Experience developing, implementing, and executing projects and managing multiple projects.
• Experience working with internal clients, operations personnel, and internal and external customers.
• Strong verbal and written communication, interpersonal, organizational, analytical, and leadership skills.
• Advanced Microsoft Excel and strong reporting and data-analysis skills.
• Must work from the Richardson, Texas headquarters on a hybrid schedule; visa sponsorship is not available.

Nice to have

• Experience supporting Texas Medicaid managed care operations, preferably within a Medicaid managed care organization, healthcare services organization, delegated entity, or vendor.
• Working knowledge of the Texas Medicaid and CHIP Uniform Managed Care Manual and Uniform Managed Care Contract.
• Hands-on experience with Texas Medicaid utilization management or care management operations.
• Experience managing contract provisions and interpreting contract requirements.
• Power BI or dashboard development and reporting experience.

Culture & Benefits

• Professional development plans and career growth support.
• Health and wellness benefits, 401(k) savings plan, and pension plan.
• Paid time off, paid holidays, and paid parental leave.
• Disability insurance, supplemental life insurance, and employee assistance program.
• Tuition reimbursement and eligibility for an annual incentive bonus plan.