Remote Clinical Operations Specialist (Benefits & Care)

GEHA Health; United States; À distance; USD 49 000 - 62 000; Plein temps

Avantages offerts par ce poste

Health benefits from day one

401(k) company match

Paid time off

Hybrid/work-from-home options

Tuition assistance

Well-being program

Résumé du poste

G.E.H.A seeks a remote Clinical Operations support professional to engage with members and providers, coordinate claims, and determine medical necessity in line with contract provisions. The role emphasizes accurate documentation, communication, and compliance with HIPAA requirements.

Responsibilities include reviewing benefits, processing routine cases, and escalating complex matters to senior staff. The position offers competitive pay, benefits from day one, and hybrid/work-from-home options

Qualifications

• Two years of college or two years of healthcare experience required.
• Ability to interpret medical review results for contract compliance.
• Proficient in Microsoft Office applications and communication.

Responsabilités

• Performs routine administrative tasks supporting Clinical Operations.
• Engages and educates members and providers about benefits.
• Coordinates, reviews and investigates claims for medical necessity.
• Escalates complex cases to senior team members.
• Directs processing of contractual benefits after investigation.

Connaissances

Provider communication

Claims coordination

Medical review

Compliance interpretation

Cost management

Benefit determination

Customer communication

Contract processing

Escalation procedures

Healthcare experience

MS Office

Formation

Two years college

Healthcare experience

Outils

Microsoft Outlook

Microsoft Excel

Microsoft Word

Teams

Description du poste

G.E.H.A seeks a remote Clinical Operations support professional to engage with members and providers, coordinate claims, and determine medical necessity in line with contract provisions. The role emphasizes accurate documentation, communication, and compliance with HIPAA requirements.

Responsibilities include reviewing benefits, processing routine cases, and escalating complex matters to senior staff. The position offers competitive pay, benefits from day one, and hybrid/work-from-home options