Healthcare Claims Operations Expert
Job Summary
Seeking an experienced Healthcare Claims Operations Expert for a full-time contract position, the candidate will manage the complete healthcare claims lifecycle, ensuring accurate processing and compliance while working remotely.
Key responsibilities
- Manage the complete healthcare claims lifecycle, from intake to payment and adjustments
- Review and resolve complex medical, dental, vision, and pharmacy claims
- Drive process improvement, automation, and operational excellence initiatives
Required qualifications
- 8+ years of experience in US Healthcare Payer Operations
- Strong expertise in medical claims processing and adjudication
- Familiarity with Medicare, Medicaid, and commercial insurance
- Experience with payer platforms such as Facets, QNXT, and HealthRules
- Advanced Excel skills and knowledge of SQL
COMPLETE JOB DESCRIPTION
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