Claims Operations
Employment Information
Report this job
Job expired or something wrong with this job?
Job Description
Claims Reimbursement Analyst developing reimbursement guidelines and collaborating with stakeholders at CareSource. Supporting Claims Operations and ensuring compliance with reimbursement processes.
Responsibilities:
- Execute and support the tasks to develop, implement and maintain reimbursement guidelines for assigned CareSource Products
- Collaborate with key stakeholders and Product to ensure Claims Reimbursement process and procedures align with the overall strategy
- Participate in Benefit Interpretation support
- Support required legislative and regulatory reviews
- Assist in the tasks to support the established budgets, timelines and task schedules
- Execute assigned tasks to collaborate with senior leadership
Requirements:
- Bachelor of Arts/Science degree in Finance, Business or health care field, or other related field
- Minimum of three (3) years of product management, reimbursement policy creation, or claims experience
- Healthcare insurance industry experience
- Familiarity of the healthcare/managed care field and knowledge of government program products
- Previous experience working with state and Federal regulators/government in a managed care setting
Benefits:
- Health insurance
- Retirement plans
- Paid time off
- Flexible work arrangements
- Professional development
- Bonuses
Report this job
Job expired or something wrong with this job?
Similar Jobs
Database Operations Engineer
DBOps Engineer ensuring the availability, reliability, scalability and security of enterprise databases across multi-cloud environments. Focusing on Infrastructure as Code (IaC) for databases and operational excellence.
Manager, Advisory Operations
Manager leading day-to-day operational execution for the Advisory practice at KSM. Overseeing engagement processes and supporting team development in a collaborative culture.
Regional Operations Manager
Regional Operations Manager leading field operations at Allegion Access Technologies. Driving growth, customer satisfaction, and team development across regional branches with leadership responsibilities.
Provider Operations Associate
Entry-level role supporting healthcare operations at Carrum Health. Collaborating with internal teams to ensure smooth operations for providers and patients.
Operations Manager, Medical Device
Operations Manager overseeing logistics and performance in the medical device sector. Leading teams across departments to ensure high service levels and operational excellence.
Senior Associate – Logistics, Live Operations, Parcel Strategy & Operations
Senior Associate for Live Operations at DoorDash, managing logistics operations across a national network. Collaborating with cross-functional teams to enhance efficiency and customer service.
Operations Assistant – Real Estate
Operations Assistant supporting real estate operations through administration, data handling, and AML checks. Entry-level position with training provided and working remotely in the Philippines.
Senior Manager, Commercial Operations
Senior Manager supporting Commercial Operations for MONARCH at Johnson & Johnson. Leading initiatives for sales reporting, forecasting, and analytics within MedTech.
Operations Director – Site Deployment
Operations Director at JLL overseeing data center transition and deployment operations. Leading strategic initiatives and multiple teams across various geographic regions.
Operations Director, Operational Excellence
Operations Director focusing on strategic leadership for data center operations and driving operational excellence in the United States. Involved in risk management, compliance, and team development.
Director of Payor Operations
Director of Payor Operations overseeing operational infrastructure and care delivery across health plan partnerships at Equip. Ensuring compliance and optimizing access and reimbursement.
Senior Manager, Commercial Operations
Senior Manager leading commercial operations for the MONARCH platform at Johnson & Johnson MedTech, focusing on sales effectiveness and operational readiness. Collaborating cross-functionally to enhance business performance and metrics utilization.
Operations Monitor
Operations Monitor responsible for tracking the stability of the 988 Lifeline. Collecting and analyzing data to support operations within a mental health nonprofit.
Service Operations Performance Manager
Service Operations Performance Manager optimizing core applications like SAP and Salesforce for SMA America. Enhancing efficiency of service operations through automation and data-driven decision making.
Multi-Cloud Lead Architect – FinOps, Cloud Platforms
Multi-Cloud Lead Architect leading a team in delivering scalable cloud solutions for FinOps. Driving cloud transformation and cost optimization initiatives across AWS, OCI, GCP, and Azure.
Analyst, Rebate Operations
Analyst managing operational aspects of rebate programs for Navitus Health Solutions. Responsible for data analysis, client support, and audit coordination in the rebate process.
Operations Delivery Manager – Retiree Health Solutions
Delivery Manager overseeing enterprise delivery operations in Retiree Health Solutions. Responsible for ensuring high-quality service delivery to plan sponsors and Medicare participants.
Field Operations Manager – Steel Division
Field Operations Manager overseeing steel field operations nationwide for NexGen. Supervising General Superintendents and ensuring project execution aligns with plans and timelines.
Senior IT Operations Analyst
Senior IT Operations Analyst at Fixify, focusing on technical leadership, customer experience, and AI integrations. Engaging in high-level support and collaboration with Engineering and Product teams.
VP, Advertising Operations
VP of Advertising Operations leading AdOps function at Cross Screen Media, optimizing video campaigns for political and public affairs agencies. Driving operational excellence and technology integration for scalable processes.