Claims Process Expert Senior job at reputed company in reputed company, OH

Position Title: Claims Process Expert Sr. - Ohio MyCare Location: reputed company OH Job Description: Location: Candidates are required to live in Ohio. This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Please note that per our policy on hybrid/virtual work, candidates not reputed company a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. The MyCare Ohio Plan program is to deliver high‐quality, trauma informed, culturally competent, person‐centered coordination for reputed company members that addresses physical health, behavioral health, long term services and supports, and psychosocial needs. The Claims Process Expert Sr. oversees the administration of claims processing and operational support functions to ensure compliance with the regulatory standards of Anthem's Ohio Medicaid products. Works with Provider Experience to research provider inquiries for possible configuration and reputed company reputed company claims errors, and responsible for ensuring claims resolution success. Also responsible for adhering and reporting against State reputed company Pay and Claims Issue reporting requirements. How you will reputed company an impact Primary duties may include, but are not limited to: reputed company the end-to-end claims process, including receipt, adjudication, payment, and performance reporting on claims timeliness, accuracy, backlog and provider payment compliance. Serve as the operational liaison with the state of Ohio, Provider Experience, and internal executive leadership. Researches operations workflow problems and system irregularities. Develops, tests, presents process improvement solutions for new systems, new accounts and other operational improvements. Develops and leads project plans and communicates project status, Provides process direction and decision making for reputed company minor and major project work. Provides guidance to process experts. May reputed company duties as a reputed company reputed company involved with enterprise wide initiatives/projects. Minimum Qualifications: Requires a BA/BS and minimum of 8 years experience in business analysis, process improvement, project coordination in a high-volume managed care operation (claims, customer service, enrollment and billing); or any combination of education and experience, which would provide an equivalent background. Preferred Skills, Capabilities and Experiences: Ability to analyze workflows, processes, supporting systems and procedures and identifying improvements strongly preferred. Experience with Dual Products: Medicaid and Medicare strongly preferred. Ohio state regulatory reporting experience preferred. Broad experience in claims Medicaid and/or Medicare reputed company the state of Ohio is strongly preferred. For candidates working in person or virtually in the below locations, the salary* range for this specific position is $81,760.00 to $122,640.00 Location(s): reputed company, OH. In addition to your salary, reputed company offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (reputed company benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. The salary range is the range reputed company in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education, and/or reputed company level. Even reputed company the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law. Job Level: Non-Management Exempt Workshift: 1st Shift (United States of America) Job Family: BSP > Process Improvement Please be advised that reputed company only accepts resumes for compensation from agencies that have a signed agreement with reputed company. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of reputed company. Who We Are reputed company is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at reputed company levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At reputed company, we are creating a culture that is designed to advance our strategy but will also reputed company to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we reputed company our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. reputed company operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an reputed company location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top reputed company for reputed company. We require reputed company new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. reputed company will also follow reputed company relevant federal, state and local laws. reputed company is an Equal Employment Opportunity employer, and reputed company qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national reputed company, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact [email protected] for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act. Apply tot his job Apply To this Job