Medicaid Functional Lead - Human Services Transformation

Our Deloitte Customer team empowers organizations to build deeper relationships with customers through innovative strategies, advanced analytics, Generative AI, transformative technologies, and creative design. We can enhance customer experiences and drive sustained growth and customer value creation and capture, through customer and commercial strategies, digital products and innovation, marketing, commerce, sales, and service. We are a team of strategists, data scientists, operators, creatives, designers, engineers, and architects. Our team balances business strategy, technology, creativity, and ongoing managed services to solve the biggest problems that affect customers, partners, constituents, and the workforce.

Work you’ll do

As a Medicaid Functional Lead - Senior Consultant on the GPS HST Technology team, you will be responsible for:

• Provide functional production support for Medicaid eligibility, enrollment, managed care, notices, and HIPAA transaction processing by investigating incidents, triaging defects, analyzing requirements, and articulating solutions.
• Coordinate with stakeholders to deliver operational enhancements and support release readiness, including functional validation and issue resolution.
• Support analysis and documentation of eligibility policies, business rules, and operational processes for public sector health and human services programs, including Medicaid, SNAP, TANF, and related benefit programs.
• Collaborate with eligibility workers, policy staff, and program stakeholders to translate legislation, policy guidance, and operational requirements into system requirements and business processes.
• Support eligibility determination design, case management workflows, notices, enrollment processes, interfaces, and program operations within integrated eligibility environments.
• Assist with development and execution of user acceptance testing (UAT), scenario-based testing, and validation of eligibility outcomes against policy requirements.
• Analyze defects, operational issues, and enhancement requests to identify business impacts and support resolution planning., * SQL/basic data analysis for reconciliation and defect investigation
• Experience supporting federal and state reporting requirements and associated data quality validation
• Familiarity with managed care enrollment, trading partner data exchanges, and enrollment reconciliation processes
• Experience supporting Enrollment on a Medicaid platform in a production environment
• Experience supporting HIPAA 834 EDI transactions and statewide Medicaid eligibility and enrollment platforms

The wage range for this role takes into account the wide range of factors that are considered in making compensation decisions including but not limited to skill sets; experience and training; licensure and certifications; and other business and organizational needs. The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the position may be filled. At Deloitte, it is not typical for an individual to be hired at or near the top of the range for their role and compensation decisions are dependent on the facts and circumstances of each case. A reasonable estimate of the current range is $102,00 to $160,000.

You may also be eligible to participate in a discretionary annual incentive program, subject to the rules governing the program, whereby an award, if any, depends on various factors, including, without limitation, individual and organizational performance.

Deloitte is committed to providing reasonable accommodations for people with disabilities. If you require a reasonable accommodation to participate in the recruiting process, please direct your inquiries to the Global Call Center (GCC) at USTalentCICInbox@deloitte.com.

Medicaid, Sales, Customer Experience, Customer Relations, Data Science, Business Strategy, Creative Design, Artificial Intelligence (AI), Marketing, Technical/Engineering Design, * Ability to work independently and collaborate as part of a team

• Effective written and verbal communication skills
• Meticulous attention to detail and quality of work product
• Ability to build and sustain professional relationships
• Ability to lead projects or workstreams
• Ability to manage and prioritize multiple tasks in a fast-paced and dynamic environment
• Strong interpersonal skills and professional demeanor
• Ability to meet deadlines, * Bachelor’s degree
• 5 + years of consulting and/or industry experience
• Current state public assistance system experience that supports eligibility and benefits determination and case management
• Experience supporting State client(s) in one or more of the following areas: eligibility determination, benefits calculation, benefits issuance, and/or information management
• Strong knowledge of Medicaid eligibility operations, including applications, determinations, renewals, enrollment, managed care, and changes in circumstances; able to translate program policies into functional requirements, business rules, and impact assessments.
• Hands-on experience with HIPAA enrollment and eligibility data exchanges, trading partners, privacy and security requirements, and sensitive member information handling.
• Skilled in managing requirements, production issues, enhancements, process flows, data mappings, interface specifications, and operational procedures across interconnected functional areas.
• Proven ability to coordinate stakeholders and workstreams, support incident and defect triage, root cause analysis, testing and release validation, and use JIRA or similar tools.
• Ability to travel 0 - 20%, on average, based on the work you do and the clients and industries/sectors you serve
• Limited immigration sponsorship may be available

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