Top 268 Field office claims specialist Jobs in Ohio

Operations Regulatory Specialist II (Dayton OH Hybrid location)
CareSource —Ohio
- $62,700 - $100,400 a year
- Full-time
- Hybrid work
- Microsoft Word
- Microsoft Excel
- Research
Customer Service - Export Specialist
Sherwin-Williams —Cleveland, OH
- $62,256 - $77,641 a year
- Full-time
- 18 years or older
- Inventory management
- Office
6d
Service Account Specialist - Billing (BSS)
Quest Diagnostics —Cleveland, OH
- From $58,000 a year
- Full-time
- Remote
- Mid-level
- 3 years
- High school diploma or GED
- Employee stock purchase plan
- Disability insurance
Quick Apply
11d
Community Engagement Specialist
SADD —Ohio
- $25 - $32 an hour
- Part-time
- Remote
- Background check
- Adults
- Research
Quick Apply
EH&S Specialist
MS Companies —Springfield, OH
- $65,000 a year
- Full-time
- Mid-level
- 3 years
- High school diploma or GED
Quick Apply
6d
Technical Product Support, MaxiDrill & Reclamation Products - American Augers
American Augers —West Salem, OH
- $55,000 - $90,000 a year
- Overtime
- Microsoft Word
- Microsoft Excel
- Construction site
- Health insurance
- Dental insurance
Accounting Operations Specialist
GoKeyless —Miamisburg, OH
- $50,000 - $57,000 a year
- Full-time
- CPA
- Bachelor of Science
- Mid-level
- Health insurance
- 401(k)
Quick Apply
10d
Canton WC Claims Specialist (PN: 20068496 & 20069012)
State of Ohio - Workers' Compensation —North Canton, OH
- $26.54 - $34.53 an hour
- Full-time
- Background check
- Microsoft Excel
- Microsoft Outlook
- Paid holidays
- Health insurance
4d
Credentialing Specialist
Integrated Services for Behavioral Health —Columbus, OH
- $23.85 - $28.02 an hour
- Full-time
- Hybrid work
- Mid-level
- Organizational skills
- 1 year
- Disability insurance
- Health insurance
Quick Apply
11d
Toledo - WC Claims Specialist (PN: 20069733)
State of Ohio - Workers' Compensation —Toledo, OH
- $26.54 - $34.53 an hour
- Full-time
- Background check
- Microsoft Excel
- Microsoft Outlook
- Paid holidays
- Health insurance
3d
Cincinnati WC Claims Specialist (PN: 20068877)
State of Ohio - Workers' Compensation —Cincinnati, OH
- $26.54 an hour
- Full-time
- Background check
- Microsoft Excel
- Microsoft Outlook
- Paid holidays
- Health insurance
5d
Fringe Benefit Support Specialist
IW Trust Fund —Vandalia, OH
- $22 - $26 an hour
- Full-time
- Hybrid work
- Background check
- Medical office experience
- Mid-level
- Disability insurance
- Health insurance
Quick Apply
Cargo Claims Administrator
Mohawk Global Logistics Corp —Cleveland, OH
- $55,000 - $65,000 a year
- Full-time
- Remote
- Microsoft Excel
- Microsoft Outlook
- 5 years
Quick Apply
Intermediate Acquisition Specialist (Remote)
GCC Technologies, LLC —Cleveland, OH
- Remote
- English
- Research
- Mid-level
Benefits & Prior Authorization Specialist
Jewish Family Service Association of Cleveland —Pepper Pike, OH
- From $26 an hour
- Part-time
- Word processing
- Medical office experience
- HIPAA
Quick Apply
5d
Claims – No-Fault Litigation Specialist I - IV
The Cincinnati Insurance Companies —Fairfield, OH
- $60,000 - $95,000 a year
- Mid-level
- Analysis skills
- Team management
Sr. Field Safety Specialist | North Region
Camping World —Ohio
- $87,400 - $134,000 a year
- Full-time
- Remote
- Up to 50% travel
- Mid-level
- 3 years
- Paid parental leave
- Health insurance
Quick Apply
4d
Revenue Cycle Coordinator III
CareSource —Dayton, OH
- $47,400 - $76,000 a year
- Full-time
- Microsoft Excel
- Public speaking
- HIPAA
Sr. Analyst, Global Risk Management
Cardinal Health —Ohio
- $68,500 - $88,020 a year
- Remote
- Mid-level
- Analysis skills
- Bachelor's degree
- Paid parental leave
- Health savings account
12d
Pharmacy Support Liaison - Patient Engagement Team (Hybrid)
University Hospitals —Warrensville Heights, OH
- $22.22 - $34.76 an hour
- Medical office experience
- Mid-level
- 3 years

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Operations Regulatory Specialist II (Dayton OH Hybrid location)

CareSource -
Ohio

Apply Now

Job Details

Full-time
$62,700 - $100,400 a year

Qualifications

Research

Full Job Description

Job Summary:

The Operations Regulatory Specialist II provides analytical support and leadership for key internal Operations projects and partners with the Operations departments to ensure all regulatory and compliance deliverables are met. This position will work Tues/Thurs in the Dayton, Ohio office and remote the other days.

Essential Functions:

Represent operations on cross-functional project work teams
Submit, monitor and prioritize IT tickets for the operations departments
Review special projects and identify issue trends and potential resolutions
Assist with reporting and processes that are regulatory related and tied to state issues deadlines
Assist with the development, drafting and review of P&P’s and job aides for Operations
Assist in educating/training Business Partners on operations functions.
Research and resolve provider claim issues and escalations by analyzing system configuration, payment policy, and claims data when requested by Compliance
Perform analysis of all claims data to provide decision support to Claims management team in relation to regulatory requests
Identify and quantify data issues within Claims and assist in the development of plans to resolve data issues
Partner and collaborate with Operations Business Owners to ensure all audit and regulatory deliverables are met accurately and on time. These deliverables may include:
- Documentation gathering – i.e. review of Standard Operating Procedure and/or Policy and Procedure to the audit/inquiry requirements
- Audit Universe monitoring and/or creation – collaboration with IT and the Business Owners to validate the accuracy of the data and formatting of the final report for submission
- Prepare Operations Business Owners for live questions and answers with the state regulators or auditors
- Track and assist with remediation efforts for Corrective Action Plans related to all audit findings
- Ensure the timeliness submission of the Regulatory Reporting required by the state and federal agencies for Operations
- Track all Compliance required training on a yearly and new hire basis for Operations
- Assist with all readiness activities in relation to implementation of a new line of business for Operations
Perform any other job-related instructions, as requested

Education and Experience:

Bachelor’s degree or equivalent years of relevant work experience required
Minimum of two (2) years of healthcare operations environment is required
Regulatory and/or compliance experience is preferred

Competencies, Knowledge and Skills:

Advanced level experience in Microsoft Word, Excel and PowerPoint
Data analysis and trending skills
Demonstrated understanding of claims operations specifically related to managed care
Advanced knowledge of coding and billing processes, including CPT, ICD-9, ICD-10 and HCPCS coding
Ability to work independently and within a team environment
Attention to detail
Familiarity of the healthcare field
Critical listening and thinking skills
Negotiation skills/experience
Strong interpersonal skills
Proper grammar usage
Technical writing skills
Time management skills
Strong communication skills, both written and verbal
Customer service orientation
Decision making/problem solving skills

Licensure and Certification:

None

Working Conditions:

General office environment; may be required to sit or stand for extended periods of time

Compensation Range:

$62,700.00 - $100,400.00

CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly/salary):

Salary

Organization Level Competencies

Fostering a Collaborative Workplace Culture
Cultivate Partnerships
Develop Self and Others
Drive Execution
Influence Others
Pursue Personal Excellence
Understand the Business

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.

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Brand=CareSource

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Refine Your Search

field office claims specialist jobs in ohio

Operations Regulatory Specialist II (Dayton OH Hybrid location)

Customer Service - Export Specialist

Service Account Specialist - Billing (BSS)

Community Engagement Specialist

EH&S Specialist

Technical Product Support, MaxiDrill & Reclamation Products - American Augers

Accounting Operations Specialist

Canton WC Claims Specialist (PN: 20068496 & 20069012)

Credentialing Specialist

Toledo - WC Claims Specialist (PN: 20069733)

Cincinnati WC Claims Specialist (PN: 20068877)

Fringe Benefit Support Specialist

Cargo Claims Administrator

Intermediate Acquisition Specialist (Remote)

Benefits & Prior Authorization Specialist

Claims – No-Fault Litigation Specialist I - IV

Sr. Field Safety Specialist | North Region

Revenue Cycle Coordinator III

Sr. Analyst, Global Risk Management

Pharmacy Support Liaison - Patient Engagement Team (Hybrid)

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This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.

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