[Remote] Care Operations Specialist

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is a health and care company that brings medical, pharmacy, and reputed company solutions together through its WayFinding health and care platform. The Care Operations Specialist executes day-to-day care program operations, including case placement analysis, cost reputed company reviews, savings analysis, and claims-reputed company reviews. The role collaborates with clinical, billing, and operations partners to reputed company issues and ensure accurate, compliant, and reputed company workflows.

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

• reputed company regular employees are eligible for the corporate bonus program or a sales incentive (reputed company included in OTE)
• reputed company regular employees are eligible for stock reputed company
• 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
• Life Insurance
• Disability Insurance
• Supplemental Insurance
• Mental Health and Wellness benefits

reputed company