Job Overview
Location
Remote
Job Type
Full-time
Category
Operations
Date Posted
May 15, 2026
Full Job Description
đź“‹ Description
- • Represent the Claims department on cross-functional project teams to ensure operational alignment and effective execution
- • Submit, monitor, and prioritize IT tickets specifically for the Claims department to address system and process needs
- • Review special projects to identify recurring issues, root causes, and potential resolutions within claims processing
- • Assist with Onbase reporting and process optimization to improve documentation and workflow efficiency
- • Develop, draft, and maintain Policies and Procedures (P&P) and job aids for Claims team members to standardize operations
- • Provide training to Claims staff on claims processing policies, procedures, and system utilization
- • Educate and train Business Partners on claims functions to enhance interdepartmental collaboration and accuracy
- • Research and resolve provider claim issues and escalations by analyzing system configurations, payment policies, and claims data
- • Conduct comprehensive analysis of all claims data to deliver actionable insights and decision support to Claims management
- • Identify and quantify data quality issues within the Claims function and support development of corrective action plans
- • Represent the Claims Department during provider calls and visits when assigned to the Research and Resolution team
- • Engage in face-to-face interaction with providers to address claims research, resolution, and service inquiries
- • Manage provider-related claim issues using established Workflow processes and tools, including Facets and Onbase
- • Contribute input to claims business requirements, testing protocols, and implementation planning for system and process changes
- • Perform additional job-related duties as assigned to support operational goals and departmental priorities
🎯 Requirements
- • Bachelor’s degree or equivalent years of relevant work experience required
- • Minimum of two (2) years of experience in a healthcare claims environment required
- • Advanced level experience in Microsoft Word, Excel, and PowerPoint required
- • Advanced knowledge of coding and billing processes including CPT, ICD-9, ICD-10, and HCPCS coding required
- • Demonstrated understanding of claims operations in a managed care setting required
- • Strong technical writing, communication, and interpersonal skills required
🏖️ Benefits
- • Compensation range of $62,700.00 - $100,400.00
- • Potential bonus tied to company and individual performance
- • Comprehensive total rewards package including well-being investments
- • Remote work option available for most locations
- • For candidates within 45 miles of Dayton, OH: hybrid schedule (2 days in office, 3 days remote)
Skills & Technologies
See exactly how your profile matches this role — strengths, skill gaps, and what to do about them.
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
MLB Network, LLC
5 months ago
Dexterra Group Inc.
5 months ago
Juniper Square, Inc.
29 days ago
