Provide analytical support and leadership for project impacting Claims and key internal Claims projects
Represent claims on cross-functional project work teams
Submit, monitor and prioritize IT tickets for the Claims department
Review special projects and identify issue trends and potential resolutions
Assist with Onbase reporting and processes
Develop and draft P&P's and job aides for Claims
Assist in training claims staff on claims processing policy and procedures
Assist in educating/training Business Partners on claims functions
Research and resolve provider claim issues and escalations by analyzing system configuration, payment policy, and claims data
Perform analysis of all claims data in order to provide decision support to Claims management team
Identify and quantify data issues within Claims and assist in the development of plans to resolve data issues
Represent Claims Department at requested provider calls and visits
Provide feedback and/or face-to-face interaction with providers for claims research and resolution
Responsible for research and resolution of claims issues for all assigned provider inquiries and submissions
Responsible for managing provider issues adhering to Workflow processes and tools (Facets and Onbase)
Provide input for claims business requirements, testing processes and implementation tasks and plans
Perform any other job related instructions, as requested

Bachelor’s degree or equivalent years of relevant work experience required
Minimum of two (2) years of healthcare claims environment is required
Advanced level experience in Microsoft Word, Excel and PowerPoint
Data analysis and trending skills
Demonstrated understanding of claims operations specifically related to managed care
Advanced knowledge of coding and billing processes, including CPT, ICD-9, ICD-10 and HCPCS coding
Ability to work independently and within a team environment
Attention to detail
Familiarity with the healthcare field
Critical listening and thinking skills
Negotiation skills/experience
Strong interpersonal skills
Proper grammar usage
Technical writing skills
Time management skills
Strong communication skills, both written and verbal
Customer service orientation
Decision making/problem solving skills

Operations Specialist II

Key skills