Operations Specialist II

Job Summary: The Operations Specialist II provides analytical support and leadership for project impacting Claims and key internal Claims projects. Essential Functions 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 aids 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 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. Research & Resolution Team Responsibilities Represent Claims Department at provider calls and visits. Provide feedback and/or face‑to‑face interaction with providers. Research and resolve claims issues for all assigned provider inquiries and submissions. Manage 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. Education and Experience Bachelor’s degree or equivalent years of relevant work experience. Minimum of two (2) years of experience in a healthcare claims environment. Competencies, Knowledge and Skills Advanced level experience in Microsoft Word, Excel and PowerPoint. Data analysis and trending skills. Demonstrated understanding of claims operations 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. Licensure and Certification None. Working Conditions General office environment; may require sitting or standing for extended periods. Compensation Range $62,700.00 - $100,400.00. Equal Opportunity Statement CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds. #J-18808-Ljbffr CareSource