Claims Specialist III

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CareSource

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Healthcare Insurance

CareSource is a health services company focused on providing affordable health insurance and healthcare solutions. It offers a wide range of plans including Medicaid, Marketplace, and Medicare Advantage, targeting low-income adults, families, children, pregnant women, elderly adults, and people with disabilities. Additionally, CareSource provides members with resources for COVID-19 support, dental, vision, and hearing benefits, as well as pharmacy services. The company emphasizes easy access to healthcare management through online platforms and a mobile app.

1001 - 5000 employees

Founded 30+ years

⚕️ Healthcare Insurance

📋 Description

• Resolve complex COB issues through member information updates and adjustment of claims • Maintain accountability for daily tasks and goals to ensure completion of requests within requested SLA and department standards • Identify potential process improvements • Process/adjust a wide variety of claims accurately and timely following established guidelines • Ensure all assigned provider issues are resolved and communicated within appropriate timeframes

🎯 Requirements

• High School Diploma or equivalent • Minimum of one (1) year of experience in claims environment or related healthcare operations experience • Previous experience in an HMO or related industry preferred • Previous Medicare/Medicaid dual eligible claims experience is preferred • Proficient in Microsoft Office Suite (Word, Excel, PowerPoint) • Medical terminology; CPT and ICD coding knowledge strongly preferred • Intermediate level data entry skills

🏖️ Benefits

• Health insurance • Retirement plans • Paid time off • Flexible work arrangements • Professional development • Bonuses