Care Operations Specialist

Transcarent; United States; Remote; USD 65,000 - 95,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

401(k) with company match

Paid time off and holidays

Life and disability insurance

Mental health and wellness benefits

Job summary

Transcarent is hiring a Remote Care Operations Specialist to support day-to-day execution of care programs. You will analyze cases, review cost shares, and support savings workflows while aligning with plan and company requirements.

The ideal candidate has 3+ years in healthcare operations and strong analytical, organizational, and communication skills to work with clinical, billing, and client teams in a fast-paced environment.

Qualifications

• 3+ years in healthcare operations, medical billing, revenue cycle, claims review or related operational role.
• Strong analytical and problem-solving abilities with attention to detail.
• Excellent interpersonal and communication skills; ability to work with diverse teams.

Responsibilities

• Execute day-to-day operational work in support of care programs with timely, accurate deliverables.
• Assist with case placement analysis by reviewing cases against plan rules and guidelines.
• Perform cost share reviews to support accurate member-facing decisions.
• Complete tickets and tasks related to savings analysis.
• Collaborate with Care Support Services to manage workload and turnaround times.
• Work with clinical, billing, and operations teams to resolve questions and delays.
• Review data, claims details, and docs to identify discrepancies and follow up.
• Document findings clearly and elevate non-standard situations when needed.
• Follow policies and workflows with high attention to detail.

Skills

Healthcare operations

Analytical skills

Detail-oriented

Communication skills

Results-oriented

Education

Diploma or related field

Job description

Remote

Job Description

The Care Operations Specialist is responsible for the day-to-day operational execution of our care programs, helping ensure a high-quality experience for our members and internal partners.

In this role, you will support case placement analysis, cost share review, and savings analysis workflows. You will work closely with the Care Support Services team and partner with internal clinical specialists, billing associates, and client and provider relationship managers to complete operational work accurately, efficiently, and in alignment with plan and company requirements.

The ideal candidate is a strong doer with an analytical mindset who is comfortable working in the details, following established processes, identifying issues, and helping drive timely resolution. This role is best suited for someone who enjoys executing operations at a high level rather than designing new workflows or programs.

What you'll do

• Execute day-to-day operational work in support of our care programs, ensuring timely, accurate, and compliant completion of assigned deliverables
• Assist with case placement analysis by reviewing cases against plan rules, requirements, and internal guidelines
• Perform cost share reviews to support accurate member-facing and internal operational decisions
• Complete tickets and supporting work related to savings analysis
• Partner closely with the Care Support Services team to help manage workload and maintain turnaround times
• Collaborate with internal clinical, billing, and operations partners to resolve questions, issues, escalations, and delays
• Review data, claims details, and supporting documentation to identify discrepancies or items requiring follow-up
• Document findings clearly and elevate non-standard situations when appropriate
• Follow established policies, procedures, and workflows while maintaining a high level of detail and accuracy

What we're looking for

• Diploma or a related field, or equivalent relevant experience
• 3+ years of experience in healthcare operations, medical billing, revenue cycle, claims review, or a related operational role
• Strong analytical and problem-solving skills, with the ability to review detailed information and make sound decisions
• Highly organized and detail-oriented, with the ability to manage multiple tasks and priorities
• Comfortable working independently and as part of a team, with minimal direct supervision
• Results-oriented, with experience meeting productivity, quality, and turnaround expectations
• Excellent interpersonal and communication skills; willingness to ask questions, speak up, and seek clarity when needed
• Comfortable in a fast-paced and evolving organization with a willingness to be flexible and support urgent operational needs

Who we are

Transcarent is the One Place for Health and Care, bringing medical, pharmacy, and point solutions together with the WayFinding experience, the first and only generative AI-powered health and care platform for health consumers.

Our WayFinding experience, paired with transparent and consumer-driven pharmacy care, 2nd.MD expert medical opinions, and virtual primary care, works seamlessly with comprehensive Care Experiences - Cancer Care, Surgery Care, and Weight Health - to support people with all of their health needs, simple or serious. More than 1,700 employers and health plans rely on us to provide information, guidance, and care, empowering health consumers with more choice, an experience they love, access to higher-quality care, and lower costs for 21 million Members. For more information, visit transcarent.com, and follow us on LinkedIn.

At Transcarent, our values guide everything we do:

People First: We prioritize our Members, clients, and each other in every decision

Care: Every decision starts with improving health and care for our Members

Resilience: We push boundaries and take the uncharted path to change an industry

Results: We take ownership, solve with speed, and deliver for our people and each other

Humble and Human: We lead with humility, bring fun to tough moments, and go further together

Preferred qualifications

• Clinical experience
• Familiarity with CPT and DRG surgical codes
• Medical billing experience, including cost share review experience
• Experience working with providers, carriers, TPAs, or other healthcare stakeholders
• Experience supporting operational workflows that require review of claims, coding-related information, or reimbursement details

Total Rewards

Individual compensation packages are based on a few different factors unique to each candidate, including primary work location and an evaluation of a candidate’s skills, experience, market demands, and internal equity. Salary is just one component of Transcarent's total package. All regular employees are also eligible for the corporate bonus program or a sales incentive (target included in OTE) as well as stock options.

Our benefits and perks programs include, but are not limited to:

• Competitive medical, dental, and vision coverage
• Competitive 401(k) Plan with a generous company match
• Flexible Time Off/Paid Time Off, 13 paid holidays
• Protection Plans including Life Insurance, Disability Insurance, and Supplemental Insurance
• Mental Health and Wellness benefits

Transcarent is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. If you are a person with a disability and require assistance during the application process, please don't hesitate to reach out!