CCA Claims Operations - R11402

CareSource is a healthcare company focused on providing quality services. The Claims Reimbursement Analyst is responsible for supporting Claims Operations work, including the implementation and management of product reimbursement strategies and processes.

Responsibilities

• 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

Skills

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

Benefits

• You may qualify for a bonus tied to company and individual performance.
• Substantial and comprehensive total rewards package.

Company Overview

• CareSource provides managed care services to Medicaid beneficiaries. It was founded in 1989, and is headquartered in Dayton, Ohio, USA, with a workforce of 1001-5000 employees. Its website is https://www.caresource.com/.

Company H1B Sponsorship

• CareSource has a track record of offering H1B sponsorships, with 9 in 2025, 39 in 2024, 35 in 2023, 22 in 2022, 37 in 2021, 28 in 2020. Please note that this does not guarantee sponsorship for this specific role.