Top 61990 Risk Management Representative Jobs

Claims Management Analyst III
CareSource —Remote
- $72,200 - $115,500 a year
- Full-time
- 5 years
- Computer literacy
- Writing skills
Health System Privacy Officer
University of Missouri Health Care —Columbia, MO
- $145,808 - $237,848 a year
- Full-time
- 7 years
- Writing skills
- HIPAA
- Paid holidays
- Health insurance
Director, Clinical Engineering & Healthcare Technology Management
University of Missouri Health Care —Columbia, MO
- $117,000 - $190,000 a year
- Full-time
- 7 years
- Master's degree
- Bachelor's degree
- Paid holidays
- Health insurance
Senior Project Engineer, NA
Vantage Data Centers Management Company LLC —Port Washington, WI
- Full-time
- Construction site
- Military
- 3 years
- AD&D insurance
- Disability insurance
Quick Apply
Supervisor, Transportation Network Management
Inland Empire Health Plan —Rancho Cucamonga, CA
- $80,059.20 - $106,059.20 a year
- Full-time
- Hybrid work
- Microsoft Word
- Mid-level
- Office
- Disability insurance
- Health insurance
13d
Insurance Senior Client Service Representative - Property & Casualty
CMR Risk & Insurance Services, Inc. —San Diego, CA
- $71,000 - $90,000 a year
- Full-time
- Hybrid work
- Microsoft Excel
- Microsoft Outlook
- Computer literacy
- Health insurance
- Dental insurance
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Senior Customer Service Representative
MASS PRECISION INC —San Jose, CA
- $85,000 - $100,000 a year
- Full-time
- Oracle
- Microsoft Outlook
- Mid-level
Outpatient Program Manager-Northern Region
KAIROS —Eugene, OR
- $80,870.40 - $98,259.20 a year
- Full-time
- LMFT
- Clean driving record
- Addiction Medicine
- AD&D insurance
- Paid holidays
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Lead Clinical Supervisor - Night Shift, CDF
DESC —Seattle, WA
- $97,701.60 - $110,540.40 a year
- Full-time
- LMFT
- Spanish
- Addiction Medicine
- Disability insurance
- Health insurance
Quick Apply
Strength and Conditioning Coach
VENESCO, LLC —Newport News, VA
- $75,000 - $78,000 a year
- Full-time
- Microsoft Word
- Microsoft Excel
- BLS Certification
Quick Apply
RISK & PATIENT SAFETY MANAGER/RN - (FT)
Cody Regional Health —Cody, WY
- Full-time
- Nursing
- Microsoft Excel
- Microsoft Outlook
Application Engineer
NSWC Mechanical Services —San Diego, CA
- $80,000 - $95,000 a year
- Full-time
- Mid-level
- Residential
- In-person
- Paid holidays
- Health insurance
Quick Apply
Value Stream Manager
Amphenol Pcd —Beverly, MA
- $110,000 - $130,000 a year
- Full-time
- Microsoft Excel
- Marketing
- 5 years
- Health insurance
- Dental insurance
Quick Apply
Training Specialist
UNITED ACTIVITIES UNLIMITED —Staten Island, NY
- $58,500 - $60,000 a year
- Weekends as needed
- Spanish
- Google Workspace
- Computer literacy
Finance Director
Community Action Alger-Marquette —Marquette, MI
- $69,284 - $71,427 a year
- Full-time
- Background check
- CPA
- Writing skills
- Health insurance
- Dental insurance
Quick Apply
Director of Accounts Payable
San Diego —Solana Beach, CA
- $100,000 - $120,000 a year
- Full-time
- CPA
- ERP systems
- Office
- Health insurance
- Dental insurance
Quick Apply
Commercial Drywall Acoustical Estimator - Project Manager
Palmer Soderberg, Inc. —Rochester, MN
- $80,000 - $130,000 a year
- Full-time
- Microsoft Excel
- Microsoft Outlook
- Construction site
- Paid holidays
- Health insurance
Quick Apply
Director of Finance and Operations
Steamboat Springs School District RE2 —Steamboat Springs, CO
- $146,178 - $157,346 a year
- Full-time
- Background check
- CPA
- Word processing
- Health insurance
- Dental insurance
Quick Apply
3d
Detailer
ACCO Engineered Systems —Pleasanton, CA
- $44.83 - $63.37 an hour
- Temporary
- Spanish
- 5 years
- Mid-level
- Employee stock ownership plan
Quick Apply
Business Development Representative
Our Hospice Of South Central Indiana —Columbus, IN
- Mid-level
- Driver's License
- Bachelor's degree

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Claims Management Analyst III

CareSource -
Remote

Apply Now

Job Details

Full-time
$72,200 - $115,500 a year

Qualifications

Employee relationship building

Full Job Description

Job Summary:

The Claims Management Analyst III is responsible for leading eBusiness initiatives and coordination of activities across multiple functional areas.

Essential Functions:

Manage the EDI (Electronic Data Interchange) trading partners and network of clearinghouses to ensure accurate and timely exchange of information
Works closely with Vendor Management to improve and maintain the trading partner agreement with the trading partners. This includes cost reduction and adding services
Develop and maintain a partnership with the trading partner account representatives
Manage trading partner performance, establish and monitor service level agreements, regulatory requirements, and contractual metrics
Provide Subject Matter Expertise (SME) to all departments regarding eBusiness specific EDI transactions
Build, sustain and leverage relationships to constantly allow for continuous improvement of the EDI business process
Responsible for eBusiness EDI requirements that support regulatory, compliance, and business needs And eBusiness EDI regulatory reporting
Provide critical reporting and analysis of functional performance, and make recommendations for enhancements, cost savings initiatives and process improvements
Review and analyze the effectiveness and efficiency of existing processes and systems, and participate in development of solutions to improve or further leverage these functions
Participate in the process of estimating initiative budgets as well as developing business cases and tracking the benefits
Understand business strategy, define and lead eBusiness initiatives such as working with IT and others internal departments to automate functions
Understand the process to receive claims, claims rejections and denial processes, claims payment methodologies, adjudication processing, and Encounters to enable synergies among It and business groups
Contribute to and/or develop user stories or provide user story guidance for sprint planning
Develop, document and perform testing and validation as needed
Develop and maintain an in-depth knowledge of the company’s business and regulatory environments
Identify issues, risks, and mitigation opportunities
Perform any other job duties as requested

Education and Experience:

Bachelor’s degree or equivalent years of relevant work experience is required
Minimum of five (5) years of health care operations experience in insurance, managed care, or related industry is required

Competencies, Knowledge and Skills:

Advanced knowledge of healthcare EDI files (837, 277CA, 999, 270/271, 276/277, etc.)
Advanced computer skills
Demonstrated exceptional communication (verbal and written) and high level of professionalism
Data analysis and trending skills to include query writing Knowledge of Claims IT processes and systems
Working knowledge of managed care and health claims processing
Ability to effectively interact with all levels of management within the organization and across multiple organizational layers
Demonstrates excellent analysis, collaboration skills, facilitation and presentation skills
Strong interpersonal, leadership and relationship building skills
Decision making and problem solving skills
Ability to work independently and within a team environment
Time management skills; capable of multi-tasking and prioritizing work
Attention to detail
Effective decision making / problem solving skills
Critical thinking and listening skills

Licensure and Certification:

None

Working Conditions:

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

Compensation Range:

$72,200.00 - $115,500.00

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.

#LI-RW1

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Refine Your Search

Risk Management Representative jobs

Claims Management Analyst III

Health System Privacy Officer

Director, Clinical Engineering & Healthcare Technology Management

Senior Project Engineer, NA

Supervisor, Transportation Network Management

Insurance Senior Client Service Representative - Property & Casualty

Senior Customer Service Representative

Outpatient Program Manager-Northern Region

Lead Clinical Supervisor - Night Shift, CDF

Strength and Conditioning Coach

RISK & PATIENT SAFETY MANAGER/RN - (FT)

Application Engineer

Value Stream Manager

Training Specialist

Finance Director

Director of Accounts Payable

Commercial Drywall Acoustical Estimator - Project Manager

Director of Finance and Operations

Detailer

Business Development Representative

I want to receive the latest job alert for Risk Management Representative

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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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