Operations Specialist

Job Summary

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

Key Responsibilities

• Conduct regulatory reporting and serve as a high dollar claims reviewer
• Act as primary Claims Representative for corporate projects and external audits
• Lead initiatives to automate claim functions and develop policies 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 knowledge of coding and billing processes, including CPT, ICD-9, ICD-10, and HCPCS coding
• Experience in data analysis and trending
• Demonstrated understanding of claims operations related to managed care