(USA) Manager, Project Management - Medicare Compliance Oversight

Manager, Medicare Compliance Oversight

Walmart Claims Services administers casualty claims for Walmart Inc., its subsidiaries and affiliates, and Walmart's insurance carriers. This includes adjusting customer and associate claims on behalf of Walmart, Sam's Club, and Supply Chain. The Manager, Medicare Compliance Oversight, is responsible for supporting and optimizing the Medicare compliance program at Walmart Claims Services.

Program oversight is critical for success. In this role, you will serve as an expert in Medicare compliance, internal compliance protocols and impacts to claims handling. You will continually analyze the overall Medicare compliance program and its processes to ensure our business operates in a best-in-class manner while adhering to Medicare's requirements and regulatory updates. You will lead Medicare compliance education for the organization and drive change management.

Manage Section 111 reporting by carefully reviewing claims data to ensure all reportable claims are accurately and timely updated ahead of key quarterly reporting cycles and driving necessary corrections.

Lead Medicare compliance efforts and influence Walmart Claims Services to align with requirements by identifying insights and opportunities for improvement and facilitating corrective action.

Analyze data from the TPRA vendor and the claims system to surface key insights and partner with the TPRA vendor, claims teams, and systems teams to implement improvements and efficiencies.

Recognize overall performance gaps in the program and design enhancement strategies that account for all stakeholders.

Provide education, consultation, and strategic support to claims professionals on complex workers' compensation settlements, including those involving structured annuities, professional administration, and Medicare Set-Asides (MSAs), to ensure alignment with regulatory requirements and internal protocols.

Collaborate with internal partners and the TPRA vendor and leverage program insights to develop and implement internal Medicare compliance educational programs for the organization.

Monitor regulatory and legal developments that require organizational change to mitigate risk and ensure ongoing compliance.

Analyze Medicare regulations and evaluate and implement internal processes to ensure compliance, including accurate reporting under Section 111, and striving to eliminate lien referrals to the U.S. Department of Treasury.

Collaborate with the TPRA vendor and legal counsel to evaluate changes in federal regulations and state statutes that impact risk and implement action plans to ensure compliance, including preventing penalties and interest related to reporting requirements or lien payment timeliness.

Demonstrate up-to-date expertise and apply it to the development, execution, and improvement of action plans by providing expert advice and guidance in the application of information and best practices; supporting and aligning efforts to meet customer and business needs; and building commitment for perspectives and rationales.

Provide and support the implementation of business solutions by building strong relationships and partnerships with key stakeholders; identifying business needs; determining and carrying out necessary processes and practices; monitoring progress and results; recognizing and capitalizing on improvement opportunities; and adapting to competing demands, organizational changes, and new responsibilities.

Model compliance with company policies and procedures and support the company's mission, values, and standards of ethics and integrity by incorporating these into the development and implementation of business plans; using the Open Door Policy; and demonstrating and assisting others with how to apply these in executing business processes and practices.

Demonstrated expertise in workers' compensation claims, including hands-on experience with complex settlements involving Medicare (e.g., Medicare Set-Asides (MSAs), structured annuities, and professional administration) and the ability to guide claim strategy in accordance with Medicare regulations and internal protocols.

Ability to identify compliance concerns and business insights by collecting and analyzing necessary data, recognizing trends and patterns, communicating findings to leaders, and recommending / implementing solutions to address concerns.

Ability to communicate clearly, respectfully, and professionally with associates, leaders, vendors, and external partners to build positive relationships, influence decisions, and drive alignment on complex claims and compliance matters.

Ability to make decisions and exercise sound judgment on complex needs by engaging with claims professionals, insurers, legal, and regulatory entities to ensure alignment with requirements, and by recommending / implementing solutions to complex claim and compliance needs.

Ability to monitor and interpret regulatory and legislative developments and legal findings, assess their impact on the organization, and translate them into practical recommendations that mitigate risk.

Ability to leverage available resources and apply strong judgment to define, recommend, and support updates to policies and processes in support of Medicare compliance goals

The above information has been designed to indicate the general nature and level of work performed in the role. It is not designed to contain or be interpreted as a comprehensive inventory of all responsibilities and qualifications required of employees assigned to this job. The full Job Description can be made available as part of the hiring process.

At Walmart, we offer competitive pay as well as performance-based bonus awards and other great benefits for a happier mind, body, and wallet. Health benefits include medical, vision and dental coverage. Financial benefits include 401(k), stock purchase and company-paid life insurance. Paid time off benefits include PTO (including sick leave), parental leave, family care leave, bereavement, jury duty, and voting. Other benefits include short-term and long-term disability, company discounts, Military Leave Pay, adoption and surrogacy expense reimbursement, and more. You will also receive PTO and / or PPTO that can be used for vacation, sick leave, holidays, or other purposes. The amount you receive depends on your job classification and length of employment. It will meet or exceed the requirements of paid sick leave laws, where applicable.

Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to a specific plan or program terms.

For information about benefits and eligibility, see One.Walmart ().

The annual salary range for this position is $70,000.00 - $130,000.00 Additional compensation includes annual or quarterly performance bonuses. Additional compensation for certain positions may also include :

Stock

Minimum Qualifications

Bachelor's degree in Business, Finance, Computer Science, or related field and 2 years' experience in project management, business, operations, or related area OR 4 years' experience in project management, business, operations, or related area.

1 year's experience working in cross-functional teams.

Preferred Qualifications

Data analytics and project management systems, Supervisory experience

Masters : Business

Project Management - Project Management Professional - Certification, Six Sigma Green Belt - Certification

Primary Location

905 Customer Dr, Bentonville, AR 72716, United States of America

Walmart and its subsidiaries are committed to maintaining a drug-free workplace and has a no tolerance policy regarding the use of illegal drugs and alcohol on the job. This policy applies to all employees and aims to create a safe and productive work environment.

Walmart, Inc. is an Equal Opportunity Employer- By Choice. We believe we are best equipped to help our associates, customers, and the communities we serve live better when we really know them. That means understanding, respecting, and valuing diversity- unique styles, experiences, identities, abilities, ideas and opinions- while being inclusive of all people.