Senior Claims Data & Provider Oversight Lead

CareSource; United States; Remote; USD 83,000 - 133,000; Full time

Job summary

CareSource is seeking an Claims Provider Data Oversight Manager to lead data-driven enhancements in claim outcomes across existing and new lines of business within the Claims organization. You will orchestrate cross-functional collaboration, mitigate risks, and guide process optimization with expert knowledge of Facets and provider data.

Strong communication and leadership are essential for success. The role requires overseeing provider data management, aligning business and technical teams, and

Qualifications

• Bachelor's degree required or equivalent work experience.
• Minimum of three years of progressive experience in provider record data, claims data management or a related field, including claims outcome analysis.
• Facets experience is required.
• Project management experience is required.

Responsibilities

• Define functional requirements for provider matching logic, Facets claim adjudication, and provider data management.
• Collaborate with cross-functional teams to implement project strategies and mitigate risks.
• Lead end-to-end provider data management to ensure accurate claim outcomes across lines of business.
• Perform data analysis and testing to identify improvements and support growth initiatives.

Skills

Facets experience

Project management

Communication skills

Analytical thinking

Cross-functional collaboration

Education

Bachelor's degree in business administration, healthcare administration, or related field

3+ years provider data/claims data management experience

Project Management Professional (PMP) certification

Tools

Microsoft Office

Facets

Job description

CareSource is seeking an Claims Provider Data Oversight Manager to lead data-driven enhancements in claim outcomes across existing and new lines of business within the Claims organization. You will orchestrate cross-functional collaboration, mitigate risks, and guide process optimization with expert knowledge of Facets and provider data.

Strong communication and leadership are essential for success. The role requires overseeing provider data management, aligning business and technical teams, and