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Operations Specialist, Payment Integrity
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Job Description
- Req#: 7544482
Employer Industry: Health Insurance
Why consider this job opportunity:
- Salary up to $83,000
- Performance-based bonus program and 401k matching
- Comprehensive medical, dental, and vision coverage for employees and their families
- Flexible time-off policy and initiatives like No-Meeting Fridays to support work-life balance
- Opportunities for professional development and mentorship within the organization
- Remote-first culture allowing collaboration from any location
What to Expect (Job Responsibilities):
- Manage key elements of recovery workflows and communications to ensure accurate claims payments
- Support daily operational tasks, including triaging and responding to provider disputes and inquiries
- Collaborate cross-functionally to drive financial savings and maintain strong provider relationships
- Contribute to process documentation and training to improve team efficiency
- Develop a deep understanding of workflows that support the payment integrity review life cycle
What is Required (Qualifications):
- 1+ year of experience in healthcare, preferably in process improvement, operations, or analytics
- Strong project management or administrative skills with the ability to multi-task
- Ability to communicate progress effectively to leadership
- Working knowledge of Excel for producing basic reports
- Understanding of healthcare topics related to physician reimbursement models and data sharing in provider partnerships
How to Stand Out (Preferred Qualifications):
- Experience with process/operational improvements in a healthcare setting
- Familiarity with payment integrity workflows and regulatory compliance standards
- Prior experience in a remote work environment
- Knowledge of healthcare analytics and data interpretation
- Strong interpersonal skills to foster collaboration across teams
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