Claims Management Analyst III
CareSource
full-time
Posted on:
Location Type: Remote
Location: Remote • 🇺🇸 United States
Visit company websiteSalary
💰 $70,800 - $113,200 per year
Job Level
Mid-LevelSenior
About the role
- Manage the EDI trading partners and network of clearinghouses to ensure accurate and timely exchange of information
- Work closely with Vendor Management to improve and maintain the trading partner agreement
- Develop and maintain a partnership with the trading partner account representatives
- Manage trading partner performance, establish and monitor service level agreements, regulatory requirements, and contractual metrics
- Provide Subject Matter Expertise (SME) to all departments regarding eBusiness specific EDI transactions
- Provide critical reporting and analysis of functional performance, and make recommendations for enhancements, cost savings initiatives and process improvements
Requirements
- Bachelor’s degree or equivalent years of relevant work experience is required
- Minimum of five (5) years of health care operations experience in insurance, managed care, or related industry is required
- Advanced knowledge of healthcare EDI files (837, 277CA, 999, 270/271, 276/277, etc.)
- Advanced computer skills
- Data analysis and trending skills to include query writing
- Knowledge of Claims IT processes and systems
Benefits
- Health insurance
- 401(k) matching
- Paid time off
- Flexible work arrangements
- Professional development opportunities
- Bonus tied to company and individual performance
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
EDIhealthcare EDI filesdata analysisquery writingClaims IT processescontractual metricsservice level agreementsregulatory requirementsperformance analysiscost savings initiatives
Soft skills
vendor managementpartnership developmentcommunicationreportingrecommendation makingprocess improvementsubject matter expertiseperformance managementorganizational skillsinterpersonal skills