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.

A successful candidate would possess these skills:

• 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

The team

Deloitte’s Government and Public Services (GPS) practice is designed for impact. Serving federal, state, and local government clients, as well as public higher education institutions, the team brings experience in strategy, technology, and operations to help clients address complex mission challenges. Within this environment, GPS HST Technology professionals support programs that improve service delivery, operational effectiveness, and constituent outcomes.

Qualifications

• 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

• 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