CCA Claims Operations

CareSource

2d

About The Position

The Claims Reimbursement Analyst is responsible to support Claims Operations work including, implementation and management of product reimbursement strategy and process. Essential Functions: Execute and support the tasks to develop, implement and maintain reimbursement guidelines for assigned CareSource Products, driving consistency, compliance, simplicity and standardization Collaborate with key stakeholders and Product to ensure Claims Reimbursement process and procedures align with the overall strategy and align to industry standard Participate in Benefit Interpretation support, including applicable grids, spreadsheets, and/or other technology based applications Support required legislative and regulatory reviews, as assigned Support required reimbursement material reviews for Claims, as required/assigned Participate in team meetings to establish and execute on detailed tasks Participate and lead initiatives, and have familiarity with, and demonstrated understanding of, CareSource products Complete tasks to support issue resolution and escalation Assist in the tasks to support the established budgets, timelines (milestones) and task schedules Assist in development of reports as required by internal stakeholders Support the identification and management of risk including implementing mitigation strategies and communicating/escalating to key stakeholders Execute assigned tasks to collaborate with senior leadership to ensure initiatives are properly funded, resourced, and managed, as assigned Lead initiatives and have familiarity with, and demonstrated understanding of CareSource’s Products Assist in development of reports as required by external governing bodies and internal stakeholders Support and execute published Claims related Policy & Procedures, detailed reports, and business decision documents to support the Claims function Provide clarification/verification for all levels regarding status/details Support the identification of technology-based solutions to support and continuously improve Claims accuracy, quality, and execution Provide guidance, support, and training to Claims and Operations Perform any other job duties as requested

Requirements

• Bachelor of Arts/Science degree in Finance, Business or health care field, or other related field, or equivalent years of relevant work experience is required
• Minimum of three (3) years of product management, reimbursement policy creation, or claims experience is required
• Healthcare insurance industry experience is required
• Familiarity of the healthcare/managed care field and knowledge of government program products is required
• Commitment to the mission and values of the CareSource Family of Companies
• Advanced proficiency level with Microsoft Office Suite (i.e. Microsoft Word, Excel, and PowerPoint)
• Responsive to a changing, fast paced/high-growth business environment, in a matrixed organization, with a demonstrated ability to execute
• High detail orientation skills
• Demonstrated excellent analysis, organizational and analytic skills
• Effective written and verbal communication skills
• Cross-functional team skills with strong interpersonal and relationship building skills
• Ability to work independently and within a team environment in a positive and supportive manner
• Ability to multi-task and prioritize work to meet project deadlines
• Critical listening and thinking skills
• Time management skills
• Display a customer service, member/provider-focused orientation
• Decision making/problem solving skills
• Strong planning, negotiating, and influencing skillset

Nice To Haves

• Previous experience working with state and Federal regulators/government in a managed care setting is preferred

Responsibilities

• Execute and support the tasks to develop, implement and maintain reimbursement guidelines for assigned CareSource Products, driving consistency, compliance, simplicity and standardization
• Collaborate with key stakeholders and Product to ensure Claims Reimbursement process and procedures align with the overall strategy and align to industry standard
• Participate in Benefit Interpretation support, including applicable grids, spreadsheets, and/or other technology based applications
• Support required legislative and regulatory reviews, as assigned
• Support required reimbursement material reviews for Claims, as required/assigned
• Participate in team meetings to establish and execute on detailed tasks
• Participate and lead initiatives, and have familiarity with, and demonstrated understanding of, CareSource products
• Complete tasks to support issue resolution and escalation
• Assist in the tasks to support the established budgets, timelines (milestones) and task schedules
• Assist in development of reports as required by internal stakeholders
• Support the identification and management of risk including implementing mitigation strategies and communicating/escalating to key stakeholders
• Execute assigned tasks to collaborate with senior leadership to ensure initiatives are properly funded, resourced, and managed, as assigned
• Lead initiatives and have familiarity with, and demonstrated understanding of CareSource’s Products
• Assist in development of reports as required by external governing bodies and internal stakeholders
• Support and execute published Claims related Policy & Procedures, detailed reports, and business decision documents to support the Claims function
• Provide clarification/verification for all levels regarding status/details
• Support the identification of technology-based solutions to support and continuously improve Claims accuracy, quality, and execution
• Provide guidance, support, and training to Claims and Operations
• Perform any other job duties as requested

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 1,001-5,000 employees