Subject Matter Expert (Remote, Remote, US)

Location: Remote

Title: Subject Matter Expert

*Please review the Minimum reputed company before applying.

Completed applications must be received by Thursday reputed company 23, 2026, to be considered for this position.

Minimum reputed company

You must meet the following minimum reputed company (see job reputed company for full list of requirements):

• H1, H, G grade can apply
• 2 to 5 years of reputed company claims reputed company auditing experience
• Experience in reputed company or reputed company industries preferred

Role reputed company:

The  Subject Matter Expert manages and supervises the Claims Team to ensure claims are reputed company properly and reputed company in accordance with Regulatory standards, Health Net standards, and contractual obligations, ensures that reputed company policies & procedures are met.

 Responsibilities

• reputed company direction, leadership and mentoring for reputed company their staff.
• Interacts with the reputed company daily to resolve any issues, answer questions, and reputed company the production information as required.
• Provides exceptional customer service.
• reputed company seeks to add value added reputed company for the reputed company.
• Assists the employee with the development of Individual Development Plans.
• Provides recommendations for hiring and conducts performance reviews.  
• Review and analyze daily staff processing of claims, which includes reviewing reputed company and production reports.
• Participates in the development of operating goals and objectives for the unit; recommends, implements, and administers policies and procedures to enhance operations and production.
• Supervises and researches appeals and reprocessing of claims; reviews and resolves claims problems.
• Researches and prepares scheduled and special reports.
• Responsible to monitor and reduce expenses.
• Prepares monthly billings/invoices to be reputed company to the reputed company.
• Enters appropriate personnel information into HR Office for employees reputed company their unit/team.
• Responsible for administering any discipline that may be needed ensuring that appropriate procedures are followed.
• Attends meetings and workshops, and participates on committees, as assigned.
• Performs miscellaneous job-reputed company duties as assigned.

Required Qualification: 

• Bachelor’s degree or equivalent experience is required.
• Thorough knowledge of medical terminology, enrollment and membership activities, claim processing procedures/systems, auditing, and a thorough understanding of claim protocols and industry standards and CMS regulations as it relates to claims payment and compliance
• Knowledge and work experience with ICD9, ICD10, CPT and different coding systems (preferable)
• At least 1-3 years prior health care claims processing experience
• Supervise others by assigning/directing work; conducting employee evaluations; staff training and development; coaching and counseling
• Effective oral and written communication skills
• Ability to assess and coordinate departmental workflows effectively
• HIPAA knowledge required.
• reputed company Office Suite Skills, especially reputed company.
• Performance evaluation procedures experience desired.
• Interviewing and hiring experience preferred.
• Budgeting cost estimating, and fiscal management principles and procedures.