Operations Specialist II

CareSource

Operations Specialist II at CareSource providing analytical support for Claims and key internal projects. Collaborating across teams to enhance claims operations and resolve issues.

Posted 5/14/2026full-timeDayton • Ohio • 🇺🇸 United StatesJuniorMid-Level💰 $62,700 - $100,400 per yearWebsite

About the role

Key responsibilities & impact

Provide analytical support and leadership for project impacting Claims and key internal Claims projects
Represent claims on cross-functional project work teams
Submit, monitor and prioritize IT tickets for the Claims department
Review special projects and identify issue trends and potential resolutions
Assist with Onbase reporting and processes
Develop and draft P&P’s and job aides for Claims
Assist in training claims staff on claims processing policy and procedures
Assist in educating/training Business Partners on claims functions
Research and resolve provider claim issues and escalations by analyzing system configuration, payment policy, and claims data
Perform analysis of all claims data in order to provide decision support to Claims management team
Identify and quantify data issues within Claims and assist in the development of plans to resolve data issues
Represent Claims Department at requested provider calls and visits
Provide feedback and/or face-to-face interaction with providers for claims research and resolution
Responsible for research and resolution of claims issues for all assigned provider inquiries and submissions
Responsible for managing provider issues adhering to Workflow processes and tools (Facets and Onbase)
Provide input for claims business requirements, testing processes and implementation tasks and plans
Perform any other job related instructions, as requested

Requirements

What you’ll need

Bachelor’s degree or equivalent years of relevant work experience required
Minimum of two (2) years of healthcare claims environment is required
Advanced level experience in Microsoft Word, Excel and PowerPoint
Data analysis and trending skills
Demonstrated understanding of claims operations specifically related to managed care
Advanced knowledge of coding and billing processes, including CPT, ICD-9, ICD-10 and HCPCS coding
Ability to work independently and within a team environment
Attention to detail
Familiarity of the healthcare field
Critical listening and thinking skills
Negotiation skills/experience
Strong interpersonal skills
Proper grammar usage
Technical writing skills
Time management skills
Strong communication skills, both written and verbal
Customer service orientation
Decision making/problem solving skills

Benefits

Comp & perks

Health insurance
Retirement plans
Paid time off
Flexible work arrangements
Professional development
Bonus tied to company and individual performance

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

data analysisclaims processingcoding and billing processesCPT codingICD-9 codingICD-10 codingHCPCS codingOnbase reportingMicrosoft WordMicrosoft Excel

Soft Skills

attention to detailcritical listeningcritical thinkingnegotiation skillsinterpersonal skillstechnical writingtime managementcommunication skillscustomer service orientationdecision making