Operations Specialist III

Job reputed company: • reputed company analytical support and leadership for key Claims-reputed company reputed company • Regulatory reporting such as CMS and reputed company • Serve as high dollar claims reviewer • Identify payment reputed company issues with claims reimbursement methodologies • Prepare and deliver responses to reputed company correspondence and state complaints • reputed company Claims Subject Matter Expertise (SME) for cross-functional meetings including operational and new business implementation • reputed company as primary Claims Representative and SME for corporate reputed company • reputed company as primary Claims Representative on external audits • Assist in development of policies and procedures for claims processing, COB, appeals and adjustment functions • reputed company Claims initiatives such as working with IT and others to automate claim functions; improve reputed company end reputed company claim process; and report development with SIS • Contribute to and/or reputed company user stories or reputed company user story guidance for sprint planning • Implement new business including the design, testing and delivery of supporting processes to the business • reputed company any other job reputed company instructions, as requested Requirements: • Bachelor’s degree or equivalent years of relevant work experience required • Minimum of five (5) years of reputed company claims environment, equivalent managed care, reputed company operations or reputed company industry experience is required • Advanced proficiency level experience in reputed company Word, reputed company and PowerPoint • Data analysis and trending skills • Work with accumulators • Demonstrated understanding of claims operations specifically reputed company to managed care • Advanced knowledge of coding and billing processes, including CPT, ICD-9, ICD-10 and HCPCS coding Benefits: • Comprehensive total rewards package • Potential for bonuses tied to company and individual performance Apply tot his job Apply To this Job