Clinical Operations Specialist

Job Summary

Engaging with members and providers, the full-time Clinical Operations Specialist will perform routine administrative tasks to support Clinical Operations, educate stakeholders about benefits, and identify cases for clinical programs while working remotely.

Key responsibilities

• Coordinate, review, and investigate claims to assess medical necessity and appropriateness of care
• Identify cases for care and cost management, escalating complex cases as needed
• Engage in communication with internal and external customers regarding care management and services

Required qualifications

• Two years of college education (60 credit hours) or two years of healthcare experience
• Intermediate proficiency with technology applications and systems
• Experience using Microsoft Office products, including Outlook, Excel, Word, and Teams
• Ability to provide a non-cellular high-speed internet service for a home office
• Dedicated workspace to ensure confidentiality of member information