Research and Resolution Specialist

Job Title Research and Resolution Specialist Agency Oklahoma Health Care Authority (OHCA) Location 4345 N Lincoln Blvd, Oklahoma City, OK 73105 Salary $25.432692 per hour Work Schedule Monday – Friday, 8:00 a.m. – 5:00 p.m. (full time) Position Purpose The Research & Resolution Specialist is responsible for accurately processing forms, referrals, reports, and special projects, ensuring compliance with CMS PDP Guidance, EGID Rules and Regulations, and HIPM regulations. The role requires effective communication, problem‑solving skills, and the ability to prioritize and manage various tasks to maintain the accuracy and efficiency of operations. Essential Functions Process all enrollment, change, and termination forms within five working days, maintaining established ranges of accuracy and productivity. Protect privacy and confidentiality of program participants’ information and comply with HIPM regulations. Correctly process Medicare changes and notifications, as well as eligibility updates from third parties, within accuracy ranges and required time constraints, in compliance with CMS Part D Program Guidance, EGID rules and regulations, and all unit procedures. Handle urgent and non‑urgent member and dependent eligibility and premium accounting referrals within accuracy ranges and required time constraints, adhering to all unit procedures and EGID rules and regulations. Review and process reports, queries, and other tasks, ensuring compliance with CMS PDP Guidance, EGID Rules and Regulations, and unit and member accounts procedures. Create and mail letters regarding active, pre‑Medicare, and Medicare enrollments, changes, disenrollments, cancellations or changes within the required accuracy ranges and adhering to all CMS PDP guidance, federal guidelines, and EGID rules. Complete special projects as assigned. Respond accurately to inquiries within established timeframes. Attend recurring unit, department, division, and agency meetings and any mandatory trainings provided by Member Accounts leadership or Human Resources. Other duties as assigned. Knowledge, Skills, and Abilities This position requires knowledge of CMS Part D Program guidance, EGID rules and regulations, HIPAA privacy requirements, and other applicable state and federal compliance standards related to eligibility and benefits administration. The employee must be skilled in accurately processing forms, reports, referrals, queries, and eligibility updates within established timeframes and accuracy expectations. The role requires the ability to organize and prioritize daily, weekly, and monthly workload, maintain high productivity, identify and resolve discrepancies, use tracking systems to meet required deadlines, and communicate clearly and professionally with internal and external customers. The employee must also protect confidential information, collaborate with others to resolve issues, and demonstrate the Korn Ferry competencies of Ensures Accountability, Action Oriented, and Communicates Effectively. Education and Experience Bachelor’s degree and 1 year of experience in the health insurance industry in areas such as benefits analysis, claims review or analysis, or medical/dental review or report preparation. OR an equivalent combination of education and experience, substituting one year of experience for each year of the required education. Preference Qualifications A bachelor’s degree. 2 years of experience in bookkeeping work, insurance eligibility determination or closely related work. 2 years of experience in the maintenance, analysis, and reconciliation of insurance or benefits accounts. Physical Demands and Work Environment Work is typically performed in an office setting with climate‑controlled conditions and exposure to moderate noise levels. Employees are required to speak, stand, walk, and reach with their hands and arms, and the position requires extended periods of sitting and daily use of computers and phones. Being present at the office is an essential function of this position. Accommodation Statement The Oklahoma Health Care Authority complies with applicable State and Federal civil rights laws and does not discriminate. All qualified applicants will receive consideration for employment without regard to race, color, sex, religion, disability, age, national origin, or genetic information. If a reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact the Civil Rights Coordinator at View phone number on click.appcast.io. Equal Opportunity Employment The State of Oklahoma is an equal opportunity employer and does not discriminate on the basis of genetic information, race, religion, color, sex, age, national origin, or disability. #J-18808-Ljbffr State of Oklahoma