Healthcare Claims Operations Specialist

Job Summary

Supporting healthcare claims administration, the remote Healthcare Claims Operations Specialist will manage stipend payments for Primary Family Caregivers, analyze complex claims and payment issues, and drive process improvements while ensuring compliance and efficiency.

Key responsibilities:

• Oversee accurate processing of stipend payments, validating inputs and resolving discrepancies
• Translate payment operations requirements into standard operating procedures and training materials
• Collaborate with technology teams to enhance systems and validate payment-related business rules

Required qualifications:

• Bachelor's degree in Healthcare Administration, Business Administration, Finance, or a related discipline
• Seven or more years of relevant experience in healthcare claims operations or government healthcare programs
• Hands-on experience across the healthcare claims lifecycle, including payment processing and dispute resolution
• Experience supporting a federal healthcare program or government payer environment
• Proficiency in Microsoft Office applications and reporting tools