Hiring: Medicare Operations Analyst Company: Partnership HealthPlan of California Location: Fairfield, CA Job Posted Time: 2026-09-10 07:38:56 Target Skills & Keywords : Compliance, TestNG About the job Experience: •Eight (8) years of relevant health plan operations experience is •Required. Three (3) to five (5) years of experience in Medicare DSNP •Operations. Strong knowledge of CMS regulations. Experience with •Auditing, compliance monitoring, and performance reporting. •Operational familiarity with NCQA standards. Experience working with delegated Required Skills: •Validates file intake, effective dates, transaction codes (add/change/term), and •Validates compliance with CMS enrollment rules, including effective dates and •Monitors enrollment files and reconciliation processes to ensure timely and accurate •Confirms vendor logic for ID cards, ANOCs/EOCs, welcome kits, PCP assignments. •Validates fee schedules, OON rules, bundling/unbundling edits, prior auth linkages. •Validates IVR menus, skills-based routing, disaster recovery, and call recording •Reviews scripts, FAQs, compliance call flows (no steering/misleading), language access •Ensures delegated UM/CM programs meet regulatory standards. Qualifications: •Bachelor’s degree in healthcare administration, Business, or related •Field (or equivalent experience). In lieu of a degree, a minimum of •Special Skills, Licenses and Interested candidates, please apply directly through the job posting on company's career page or try via AI auto apply on this platform. Don't miss this opportunity to join a forward-thinking team!