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CareSource · 3 hours ago

CCA Claims Operations

United States

Full-time

Remote

Mid Level

$63K/yr - $100K/yr

3+ years exp

CareSource is a healthcare management company, and they are seeking a Claims Reimbursement Analyst to support Claims Operations work. The role involves implementing and managing product reimbursement strategies and processes, collaborating with stakeholders, and ensuring compliance with industry standards.

Health CareMedicalNon Profit

Comp. & Benefits

H1B Sponsor Likely

Responsibilities

Execute and support the tasks to develop, implement and maintain reimbursement guidelines for assigned CareSource Products, driving consistency, compliance, simplicity and standardization

Collaborate with key stakeholders and Product to ensure Claims Reimbursement process and procedures align with the overall strategy and align to industry standard

Participate in Benefit Interpretation support, including applicable grids, spreadsheets, and/or other technology based applications

Support required legislative and regulatory reviews, as assigned

Support required reimbursement material reviews for Claims, as required/assigned

Participate in team meetings to establish and execute on detailed tasks

Participate and lead initiatives, and have familiarity with, and demonstrated understanding of, CareSource products

Complete tasks to support issue resolution and escalation

Assist in the tasks to support the established budgets, timelines (milestones) and task schedules

Assist in development of reports as required by internal stakeholders

Support the identification and management of risk including implementing mitigation strategies and communicating/escalating to key stakeholders

Execute assigned tasks to collaborate with senior leadership to ensure initiatives are properly funded, resourced, and managed, as assigned

Lead initiatives and have familiarity with, and demonstrated understanding of CareSource’s Products

Assist in development of reports as required by external governing bodies and internal stakeholders

Support and execute published Claims related Policy & Procedures, detailed reports, and business decision documents to support the Claims function

Provide clarification/verification for all levels regarding status/details

Support the identification of technology-based solutions to support and continuously improve Claims accuracy, quality, and execution

Provide guidance, support, and training to Claims and Operations

Perform any other job duties as requested

Qualification

Claims experienceReimbursement policy creationHealthcare insurance experienceMicrosoft Office SuiteProduct managementAnalytical skillsCommunication skillsTeamwork skillsTime managementProblem solving

Required

Bachelor of Arts/Science degree in Finance, Business or health care field, or other related field, or equivalent years of relevant work experience is required

Minimum of three (3) years of product management, reimbursement policy creation, or claims experience is required

Healthcare insurance industry experience is required

Familiarity of the healthcare/managed care field and knowledge of government program products is required

Commitment to the mission and values of the CareSource Family of Companies

Advanced proficiency level with Microsoft Office Suite (i.e. Microsoft Word, Excel, and PowerPoint)

Responsive to a changing, fast paced/high-growth business environment, in a matrixed organization, with a demonstrated ability to execute

High detail orientation skills

Demonstrated excellent analysis, organizational and analytic skills

Effective written and verbal communication skills

Cross-functional team skills with strong interpersonal and relationship building skills

Ability to work independently and within a team environment in a positive and supportive manner

Ability to multi-task and prioritize work to meet project deadlines

Critical listening and thinking skills

Time management skills

Display a customer service, member/provider-focused orientation

Decision making/problem solving skills

Strong planning, negotiating, and influencing skillset

Preferred

Previous experience working with state and Federal regulators/government in a managed care setting

Benefits

You may qualify for a bonus tied to company and individual performance.

Substantial and comprehensive total rewards package.

Company

CareSource

Glassdoor3.8

CareSource provides managed care services to Medicaid beneficiaries.

Founded in 1989

Dayton, Ohio, USA

1001-5000 employees

https://www.caresource.com/

H1B Sponsorship

CareSource has a track record of offering H1B sponsorships. Please note that this does not guarantee sponsorship for this specific role. Below presents additional info for your reference. (Data Powered by US Department of Labor)

Distribution of Different Job Fields Receiving Sponsorship

Represents job field similar to this job

Trends of Total Sponsorships

2025 (9)

2024 (39)

2023 (35)

2022 (22)

2021 (37)

2020 (28)