Job Description

Public Trust: MBI (T2)

Requisition Type: Regular

Your Impact

Own your opportunity to work alongside federal civilian agencies. Make an impact by providing services that help the government ensure the well being of U.S. citizens.

Job Description

Contribute to the strategic direction of the business and support impactful mission outcomes as a Healthcare TPA Business Operations Manager at GDIT. Here, you’ll enable the success of the most critical government missions and the growth of a meaningful career in Program Management.

As a TPA Business Operations Manager, the work you’ll do at GDIT will be impactful to the mission of a federal health program. You will play a crucial role in ensuring patients receive quality healthcare.

This role is fully remote!

This role has a targeted start date towards the end of 2025/early 2026.

Responsibilities:

• Plan, establish, execute, control, and optimize administrative healthcare business operations associated with a limited public health plan.
• Oversee day-to-day operations of federal Health Program TPA activities, ensuring efficient service delivery and compliance with CMS and federal standards.
• Ensure all operations related to Member and Provider Enrollment, Credentialing, Claims Administration, and Payments are delivered in accordance with SLAs and QASP metrics.
• Drive delivery of business outcomes with the highest quality of care, equity, and stakeholder satisfaction.
• Develop, implement, and monitor operational policies, SOPs, and performance dashboards to continuously improve service quality and program results.
• Coordinate across clinical centers, administrative teams, vendors, and federal stakeholders to ensure seamless execution of program activities.
• Manage budgets, resource allocation, workload distribution, and operational priorities to meet deadlines and ensure fiscal responsibility.
• Monitor performance data, prepare leadership reports, and identify trends, risks, compliance issues, and opportunities for continuous improvement.
• Oversee vendor and contractor performance, ensuring adherence to contractual obligations, SLAs, and compliance with HIPAA, and program requirements.
• Lead operational readiness for new regulations, policies, services, and technology implementations, including change management and training.
• Serve as a primary point of contact for escalated issues, member grievances, and provider concerns, driving timely resolution and root-cause analysis.
• Manage a large team

Required Qualifications:

• Bachelor’s degree in healthcare administration, Public Health, Business Administration, or related field (Master’s preferred).
• 7–10+ years in healthcare operations management, with at least 3–5 years in federal or public sector health programs (Medicaid, Medicare, VA, DoD, or CDC/NIOSH programs).
• Strong knowledge of healthcare delivery systems, managed care operations, claims processing, and quality improvement methodologies.
• Experience leading large-scale operations in a TPA, Medicaid Enterprise System (MES), or public health program.
• Demonstrated success in managing budgets, contracts, SLAs, and performance metrics in a regulated environment.
• Skilled in vendor/contractor oversight, procurement processes, and performance-based vendor management.
• Strong understanding of healthcare regulations (HIPAA, ACA, Medicaid/Medicare rules, CMS QASP, NIST/FedRAMP security).
• Proficiency with healthcare management systems (provider enrollment systems, claims adjudication systems) and data analytics tools (Power BI, Tableau, etc.).
• Experience managing a large team.
• Ability to obtain and maintain a Public Trust.

Preferred Qualifications:

• Preferred certifications: CPHQ (Certified Professional in Healthcare Quality), PMP (Project Management Professional), Lean Six Sigma, ITIL, or CHC (Certified in Healthcare Compliance).
• Excellent leadership, stakeholder engagement, and change management skills.
• Ability to manage cross-functional teams, including clinical, operational, and IT resources.

#GDITFedHealthJobs

Work Requirements

Years of Experience

7 + years of related experience

* may vary based on technical training, certification(s), or degree

Certification

Travel Required

Less than 10%

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