Operations Specialist II

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November 10

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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

• Provide analytical support and leadership for projects impacting Claims and key internal Claims projects • Represent claims on cross-functional project work teams • Submit, monitor and prioritize IT tickets for the Claims department • Review special projects and identify issue trends and potential resolutions • Assist with Onbase reporting and processes • Develop and draft P&P’s and job aides for Claims • Assist in training claims staff on claims processing policy and procedures • Assist in educating/training Business Partners on claims functions • Research and resolve provider claim issues and escalations • Perform analysis of all claims data to provide decision support to Claims management team • Identify and quantify data issues within Claims and assist in the development of plans to resolve data issues • Represent Claims Department at requested provider calls and visits • Responsible for research and resolution of claims issues for all assigned provider inquiries and submissions • Responsible for managing provider issues adhering to Workflow processes and tools (Facets and Onbase) • Provide input for claims business requirements, testing processes and implementation tasks and plans.

🎯 Requirements

• Bachelor’s degree or equivalent years of relevant work experience required • Minimum of two (2) years of healthcare claims environment is required • Advanced level experience in Microsoft Word, Excel and PowerPoint • Data analysis and trending skills • Demonstrated understanding of claims operations specifically related to managed care • Advanced knowledge of coding and billing processes, including CPT, ICD-9, ICD-10 and HCPCS coding • Ability to work independently and within a team environment • Attention to detail • Familiarity of the healthcare field • Critical listening and thinking skills • Negotiation skills/experience • Strong interpersonal skills • Proper grammar usage • Technical writing skills • Time management skills • Strong communication skills, both written and verbal • Customer service orientation • Decision making/problem solving skills.

🏖️ Benefits

• In addition to base compensation, you may qualify for a bonus tied to company and individual performance. • Comprehensive total rewards package.