Senior Manager Government Program Operations (Exchange)

Senior Manager Government Program Operations (Exchange)The Senior Manager, Government Programs Operations is responsible for the overall implementation, operational oversight, and change management of regulatory requirements for Exchange lines of business. This role leads the delivery of regulatory reporting, claims operations support, audit readiness, and client deliverables, ensuring compliance with federal and state requirements. The person will collaborate with Legal/Regulatory teams, internal subject matter experts, and client stakeholders to interpret CMS and state guidance and translate requirements into operational processes, system capabilities, and scalable solutions.

Through research, analysis, testing, and validation, this role ensures that Exchange program operations achieve contractual, regulatory compliance, and business performance objectives.Position Responsibilities:Lead Government Programs support for Exchange operations, including claims adjudication, regulatory reporting, and audit support (Government and Client)Oversee day-to-day operational performance for Exchange programs, ensuring alignment with contractual, regulatory requirements, and client expectationsLead the interpretation, implementation, and monitoring of federal and state regulatory requirements impacting Exchange lines of businessCollaborate cross-functionally with SMEs (Claims, Product, Technology, Compliance, Legal) to assess regulatory impacts and ensure timely, coordinated implementation of required changesDesign, document, and scale operational processes that enable accurate, compliant, and efficient service deliveryDefine business and system requirements to support compliant claims processing, data accuracy, and reporting outcomesLead regulatory reporting activities and ensure completeness, accuracy, and timeliness of all required submissionsSupport internal and external audits by federal and state agencies, including audit preparation, documentation, issue response, and remediation trackingMonitor Exchange program operations to identify and resolve issues, including root cause analysis and implementation of corrective actionsPartner with stakeholders to manage error handling, operational exceptions, and process improvements across claims and reporting functionsIdentify opportunities to enhance operational performance, compliance, and scalability through process improvement and innovationOwn and maintain documentation of policies and procedures, reporting specifications, job aids, and workflows for Government Programs OperationsMaintain current knowledge of Exchange regulatory requirements and market trends to support compliance and strategic decision-makingProvide data-driven insights to improve operational effectiveness, reporting accuracy, and overall program performanceFoster a high-performance culture through mentoring, collaboration, and ongoing performance feedbackAssess impact of new business and regulatory changes to ensure appropriate scalability, resource planning, and organizational readinessRequired Qualifications:6+ years of relevant Prescription Benefit Management and/or Health Plan experience supporting Exchange programs5+ years people management experienceSubject matter expertise of Exchange regulatory requirements and associated product and/or operational workflowsDemonstrated experience supporting regulatory reporting, audits, and compliance activitiesExtremely flexible, highly organized, and able to shift priorities easilyAttention to detail & commitment to delivering high quality work productExcellent written and verbal communication skillsProven success managing cross functional teams and maintaining effective relationships at all levels both internal and external; including government entitiesStrong operational mindset with experience improving processes and driving executionAbility to translate regulatory guidance into business and system requirementsExtremely flexible, highly organized, and able to shift priorities in a fast-paced environmentStrong analytical skills and experience leveraging data to support decision-makingAttention to detail and commitment to delivering high-quality work productExcellent written and verbal communication skillsProven ability to manage cross-functional teams and build effective relationships across internal and external stakeholders, including government entities