Operations Specialist II

Job not on LinkedIn

🔥 1 hour ago

🇺🇸 United States – Remote

💵 $62.7k - $100.4k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

⚙️ Operations

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CareSource

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 30+ years

⚕️ Healthcare Insurance

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.

📋 Description

• Provide analytical support and leadership for project 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 • Research and resolve provider claim issues and escalations by analyzing system configuration, payment policy, and claims data • Identify and quantify data issues within Claims and assist in the development of plans to resolve data issues

🎯 Requirements

• Bachelor’s degree or equivalent years of relevant work experience • 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

🏖️ Benefits

• Comprehensive total rewards package • Bonus tied to company and individual performance