Claims Reimbursement Analyst

Job Summary:

The Claims Reimbursement Analyst is responsible to support Claims Operations work including, implementation and management of product reimbursement strategy and process.

Essential Functions:

• 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

Education and Experience:

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

Competencies, Knowledge and Skills:

• 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

Licensure and Certification:

• None

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time
• Ability to travel as required by the needs of the business

Compensation Range:
$61,500.00 - $98,400.00 CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type:
Salary

Competencies:
- Create an Inclusive Environment
- Cultivate Partnerships
- Develop Self and Others
- Drive Execution
- Influence Others
- Pursue Personal Excellence
- Understand the Business

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an inclusive environment that welcomes and supports individuals of all backgrounds.