Job Overview
Location
Remote
Job Type
Full-time
Category
Operations
Date Posted
May 13, 2026
Full Job Description
đź“‹ Description
- • The Claims Specialist III is responsible for capturing, resolving/facilitating resolution, and reporting on claim adjustment requests, playing a critical role in ensuring accurate and timely claims processing for CareSource’s members and providers.
- • Day-to-day responsibilities include resolving complex COB issues through member information updates and claim adjustments, processing a wide variety of claims accurately and timely following established guidelines, assisting providers with inquiries (e.g., medical coding, explanation of benefits, appeal procedures), identifying and trending claims payment errors to determine root causes, and ensuring reporting compliance with regulatory bodies such as ODJFS, MDCH, CMS, OFIR, NCQA, and URAC.
- • The role involves acting as a technical resource for training, providing job shadowing, departmental communication, and coaching peers, while collaborating with Configuration, Network Operations, and Service Center teams to resolve payment errors through the PDSA (Plan, Do, Study, Act) cycle for continuous process improvement.
- • The Claims Specialist III works within CareSource Management Group Company, a managed care organization dedicated to improving health outcomes and fostering an inclusive workplace culture, where the individual can develop expertise in healthcare claims, regulatory compliance, and process optimization while contributing to team goals and SLA adherence.
- • In this role, the person can achieve mastery in medical billing practices, HIPAA and federal/state healthcare regulations, advanced claims adjudication, and cross-functional collaboration, while building leadership skills through coaching and feedback, and positioning themselves for advancement in healthcare operations or managed care.
🎯 Requirements
- • High School Diploma or equivalent required
- • Minimum of one (1) year of experience in a claims environment or related healthcare operations
- • Proficient in Microsoft Office Suite (Word, Excel, PowerPoint)
- • Excellent written and verbal communication skills
- • Ability to work independently and within a team environment
- • Strong interpersonal skills and high level of professionalism
🏖️ Benefits
- • Hourly compensation range of $41,200.00 - $66,000.00
- • Opportunity to qualify for performance-based bonuses tied to company and individual performance
- • Comprehensive total rewards package focused on employee well-being
- • Opportunities for training, job shadowing, and coaching others
- • Exposure to regulatory compliance (HIPAA, ODJFS, CMS, NCQA, URAC) and process improvement methodologies (PDSA)
- • Remote work flexibility
Skills & Technologies
About CareSource Management Group Company
CareSource is a nonprofit, multi-state managed care organization headquartered in Dayton, Ohio. Founded in 1989, it administers Medicaid, Medicare Advantage, and Marketplace health plans serving over two million members in Ohio, Kentucky, Indiana, West Virginia, and Georgia. The company focuses on improving health outcomes for low-income and vulnerable populations through integrated care management, behavioral health services, and social determinants programs.
Subscribe to the weekly newsletter for similar remote roles and curated hiring updates.
Newsletter
Weekly remote jobs and featured talent.
No spam. Only curated remote roles and product updates. You can unsubscribe anytime.
Similar Opportunities
Flock Safety Inc.
2 months ago
Hims & Hers Health, Inc.
2 months ago
Numeral SAS
2 months ago
