Job Overview
Location
Remote
Job Type
Full-time
Category
Operations
Date Posted
May 13, 2026
Full Job Description
đź“‹ Description
- • The Operations Specialist III provides analytical support and leadership for key Claims-related projects, playing a critical role in ensuring accurate, compliant, and efficient claims processing within a healthcare managed care environment.
- • Day-to-day responsibilities include conducting regulatory reporting for CMS and Medicaid Prompt Pay, reviewing high-dollar claims, identifying payment integrity issues, preparing responses to legal and state complaints, serving as a Claims Subject Matter Expert in cross-functional meetings, leading initiatives to automate claim functions and improve paper claim processes, contributing to user story development for sprint planning, and supporting new business implementation through process design and testing.
- • The role operates within CareSource Management Group Company, a mission-driven healthcare organization dedicated to improving access to quality care, where the Claims team ensures financial integrity and operational excellence across reimbursement, appeals, and adjustment functions.
- • The incumbent will develop deep expertise in healthcare claims operations, regulatory compliance, and data-driven process improvement; gain leadership experience in cross-functional projects; enhance technical and analytical skills in Excel, PowerPoint, and claims systems; and build strategic influence through policy development, audit support, and negotiation with internal and external stakeholders.
🎯 Requirements
- • Bachelor’s degree or equivalent years of relevant work experience
- • Minimum of five (5) years of healthcare claims environment, equivalent managed care, healthcare operations or professional industry experience
- • Advanced proficiency level experience in Microsoft Word, Excel and PowerPoint
- • Data analysis and trending skills
- • Advanced knowledge of coding and billing processes, including CPT, ICD-9, ICD-10 and HCPCS coding
- • Effective communication skills
🏖️ Benefits
- • Base compensation range of $72,200.00 - $115,500.00
- • Eligibility for performance-based bonus tied to company and individual results
- • Comprehensive total rewards package focused on employee well-being
- • Opportunity to work remotely
- • Opportunities to lead process improvement and automation initiatives with IT and business teams
- • Exposure to regulatory reporting (CMS, Medicaid) and external audit coordination
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.
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