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
Research and resolve provider claim issues and escalations by analyzing system configuration, payment policy, and claims data
Identify and quantify data issues within Claims and assist in the development of plans to resolve data issues

Bachelor’s degree or equivalent years of relevant work experience
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

Operations Specialist II

Key skills