Operations Specialist III

CareSource; Brasil; Teletrabalho; BRL 376.000 - 603.000; Tempo integral

Resumo da oferta

A leading healthcare organization in Brazil is seeking an Operations Specialist III to provide analytical support and leadership for key claims projects. The ideal candidate will have at least 5 years of experience in healthcare claims and must possess exceptional skills in Microsoft applications. This position offers a competitive salary range between $70,800 and $113,200, with potential bonuses based on performance.

Serviços

Comprehensive total rewards package

Bonus tied to performance

Qualificações

• Minimum of five years of experience in healthcare claims or managed care.
• Demonstrated understanding of claims operations in managed care.

Responsabilidades

• Provide analytical support for Claims-related projects.
• Serve as high dollar claims reviewer.
• Act as Claims Representative on audits.

Conhecimentos

Advanced proficiency in Microsoft Word

Advanced proficiency in Excel

Advanced proficiency in PowerPoint

Data analysis skills

Effective communication skills

Attention to detail

Problem-solving skills

Formação académica

Bachelor’s degree or equivalent experience

Descrição da oferta de emprego

Job Summary:

The Operations Specialist III provides analytical support and leadership for key Claims-related projects.

Essential Functions:

• Regulatory reporting such as CMS and Medicaid Prompt Pay
• Serve as high dollar claims reviewer
• Identify payment integrity issues with claims reimbursement methodologies
• Prepare and deliver responses to legal correspondence and state complaints
• Provide Claims Subject Matter Expertise (SME) for cross-functional meetings including operational and new business implementation
• Act as primary Claims Representative and SME for corporate projects
• Act as primary Claims Representative on external audits
• Assist in development of policies and procedures for claims processing, COB, appeals and adjustment functions
• Lead Claims initiatives such as working with IT and others to automate claim functions; improve front end paper claim process; and report development with SIS
• Contribute to and/or develop user stories or provide user story guidance for sprint planning
• Implement new business including the design, testing and delivery of supporting processes to the business
• Perform any other job related instructions, as requested

Education and Experience:

• Bachelor’s degree or equivalent years of relevant work experience required
• Minimum of five (5) years of healthcare claims environment, equivalent managed care, healthcare operations or professional industry experience is required

Competencies, Knowledge and Skills:

• Advanced proficiency level experience in Microsoft Word, Excel and PowerPoint
• Data analysis and trending skills
• Work with accumulators
• 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
• Effective communication skills
• Strategic management skills
• Ability to work independently and within a team environment
• Attention to detail
• Critical listening and thinking skills
• Negotiation skills/experience
• Technical writing skills
• Time management skills
• Decision making/problem solving skills

Licensure and Certification:

• None

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time

Compensation Range:

$70,800.00 - $113,200.00

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

• Create an Inclusive Environment

• Cultivate Partnerships

• Develop Self and Others

• Drive Execution

• Influence Others

• Pursue Personal Excellence

• Understand the Business

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. #LI-RW1