Medicaid Claims Manager

Are you excited about the challenges and opportunities in large-scale data management Join the Office of Medicaid Operations within the Utah State Medicaid program as a Medicaid Claims Manager.

This position requires advanced programming experience with SQL and relational databases. Critical thinking is a must as the right answer is not always obvious or known. Having experience with claims processing and data analysis is strongly preferred.

A skills test will be administered to assess skills needed for this position prior to interviews being scheduled.

Why work for the Utah Department of Health and Human Services In addition to the richbenefits the State of Utah offers the department offers:

• 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 centerat the Cannon Health Buildingwith First Steps Day Care - contact for rates and availability or

For more information on the Utah Department of Health and Human Services please click here or Medicaid Operations please click here.

I.Core Data Querying and Analysis

• 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

II.Data Systems and Troubleshooting

• 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.

III.Reporting and Collaboration

• 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.

Technical Expertise

• Data Engineering Expertise: Proven ability to architect and implement production-ready data solutions and data transformation routines using advanced SQL.

• Analytical Data Modeling: Experience designing and building reliable analytical data models to deliver high-quality trusted datasets for stakeholders and leadership.

• Legacy System Conversion (EUC Conversion): Skill in reverse-engineering and translating complex business logic from legacy End-User Computing (EUC) tools (such as Microsoft Excel and Access including VBA macros) into stable version-controlled code.

• Data Quality & Validation: Experience implementing automated data quality checks monitoring and validation processes to ensure solution accuracy and reliability.

Policy and Domain Knowledge

• Regulatory Compliance: 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.

• Policy Interpretation: Ability to read interpret and accurately apply state and federal laws rules regulations and policies related to the Medicaid/Medicare system to inform data solution design.

• Domain Preference: Having experience with healthcare claims processing and data analysis is strongly preferred.

Soft Skills and Work Ethic

• Stakeholder Partnership: Excellent written and verbal communication skills with the ability to partner with non-technical stakeholders to capture business processes and technical specifications.

• Independent Work: Ability to plan organize and prioritize workload meet deadlines and work independently to find efficient solutions to technical challenges.

• Critical Thinking: Critical thinking is a must as the right answer is not always obvious or known

• Risks found in the typical office setting which is adequately lighted heated and ventilated e.g. safe use of office equipment avoiding trips and falls observing fire regulations etc.
• Typically the employee may sit comfortably to perform the work; however there may be some walking; standing; bending; carrying light items; driving an automobile etc. Special physical demands are not required to perform the work.

• EffectiveJuly 1 2021 State of Utah Employees must either reside in Utah or be in the process of relocating to Utah within 30 days of their start date.

• If you are hired and live outside the Wasatch Front youmayreport to a local office for your in-office days.

• This position may currently be a hybrid of both in-office and remote work days. Please note a positions eligibility for remote work is established by agency management and is subject to change at their discretion at any time and for any reason.