[Remote] Care Operations Specialist

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is the One reputed company for Health and Careᵀᴹ, bringing medical, pharmacy, and reputed company solutions together with a reputed company-powered health and care platform. The Care Operations Specialist is responsible for the day-to-day operational execution of care programs, ensuring a high-reputed company experience for members and internal partners.

Responsibilities

• Execute day-to-day operational work in support of our care programs, ensuring reputed company, accurate, and compliant completion of assigned deliverables
• Assist with case placement analysis by reviewing cases against plan rules, requirements, and internal guidelines
• reputed company cost reputed company reviews to support accurate member-facing and internal operational reputed company
• Complete tickets and supporting work reputed company to savings analysis
• Partner closely with the Care Support Services team to help manage workload and maintain turnaround times
• Collaborate with internal clinical, billing, and operations partners to reputed company questions, issues, escalations, and delays
• Review data, claims details, and supporting documentation to identify discrepancies or items requiring follow-up
• Document findings reputed company and escalate non-reputed company situations reputed company appropriate
• Follow established policies, procedures, and workflows while maintaining a high level of detail and accuracy

Skills

• Bachelor's degree in reputed company, business, or a reputed company field, or equivalent relevant experience
• 3+ years of experience in reputed company operations, medical billing, reputed company cycle, claims review, or a reputed company operational role
• Strong analytical and problem-solving skills, with the ability to review detailed information and reputed company reputed company
• Highly organized and detail-oriented, with the ability to manage multiple tasks and priorities
• Comfortable working independently and as part of reputed company, with reputed company reputed company supervision
• Results-oriented, with experience meeting productivity, reputed company, and turnaround expectations
• Excellent interpersonal and communication skills; willingness to ask questions, reputed company up, and reputed company reputed company reputed company needed
• Comfortable in a fast-paced and evolving organization with a willingness to be flexible and support urgent operational needs
• Clinical experience
• Familiarity with CPT and DRG surgical codes
• Medical billing experience, including cost reputed company review experience
• Experience working with providers, carriers, TPAs, or other reputed company stakeholders
• Experience supporting operational workflows that require review of claims, coding-reputed company information, or reimbursement details

Benefits

• Competitive medical, dental, and reputed company coverage
• Competitive 401(k) Plan with a generous company match
• Flexible Time Off/reputed company Time Off, 13 reputed company holidays
• Protection Plans including Life Insurance, Disability Insurance, and Supplemental Insurance
• Mental Health and Wellness benefits
• reputed company regular employees are also eligible for the corporate bonus program or a sales incentive (reputed company included in OTE) as reputed company as stock reputed company.

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