Operations Specialist

A company is looking for an Operations Specialist III who provides analytical support and leadership for key claims-related projects.

Key Responsibilities

Perform regulatory reporting and serve as a high dollar claims reviewer

Act as primary Claims Representative and Subject Matter Expert for corporate projects and external audits

Lead initiatives to automate claims functions and assist in developing policies and procedures for claims processing

Required Qualifications

Bachelor's degree or equivalent years of relevant work experience required

Minimum of five (5) years of experience in a healthcare claims environment or related field

Advanced proficiency in Microsoft Word, Excel, and PowerPoint

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