Provider Data & Claims Oversight Lead

CareSource; Dayton (OH); Hybrid; USD 83,000 - 133,000; Full time

Job summary

CareSource is seeking a Claims Provider Data Oversight Manager in the Dayton area to oversee enhancements in claim outcomes across existing and new lines of business. You will influence provider matching logic, facets claim adjudication, and provider data management, while leading cross-functional teams to deliver end-to-end improvements.

Ideal candidates have strong Facets knowledge, project management skills, and excellent communication for stakeholder alignment. Travel may be required.

Qualifications

• Bachelor's degree in business administration, healthcare administration, or related field; or equivalent experience.
• 3+ years of progressive experience in provider record data or claims data management; includes claims outcome analysis.
• Facets experience and project management experience required.

Responsibilities

• Define and influence provider matching logic and adjudication procedures.
• Coordinate provider data loads and provider configuration across claims processes.
• Lead cross-functional collaboration to align business and technical solutions.
• Ensure compliance with regulatory and contract obligations in new implementations.

Skills

Provider data management

Claims data analysis

Project management

Facets knowledge

Communication

Education

Bachelor's degree in business administration or healthcare administration

Tools

Facets

Microsoft Office

Job description

CareSource is seeking a Claims Provider Data Oversight Manager in the Dayton area to oversee enhancements in claim outcomes across existing and new lines of business. You will influence provider matching logic, facets claim adjudication, and provider data management, while leading cross-functional teams to deliver end-to-end improvements.

Ideal candidates have strong Facets knowledge, project management skills, and excellent communication for stakeholder alignment. Travel may be required.