Operations Specialist II

Operations Specialist II

The Operations Specialist II provides analytical support and leadership for project impacting Claims and key internal Claims projects.

Essential Functions :

• 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 by analyzing system configuration, payment policy, and claims data.
• Perform analysis of all claims data in order 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
• If assigned to Research and Resolution team, responsibilities include :
• Represent Claims Department at requested provider calls and visits
• Provide feedback and / or face-to-face interaction with providers for claims research and resolution
• 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
• Perform any other job related instructions, as requested

Education and Experience :

Competencies, Knowledge and Skills :

Licensure and Certification :

Working Conditions :

Compensation Range : $61,500.00 - $98,400.00

CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly / salary) : Salary

Organization Level Competencies

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an inclusive environment that welcomes and supports individuals of all backgrounds.