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CareSource
CareSource
1 001 – 5 000 Darbuotojai
H1B vizos rėmėjasDraudimasSveikatos draudimasSveikatos priežiūra
CareSource yra sveikatos draudimo bendrovė, aptarnaujanti savo narius per Medicaid, Marketplace ir Medicare Advantage planus. Jos draudimo apsauga ir pagalbos paslaugos skirtos įvairioms grupėms, įskaitant mažas pajamas gaunančius suaugusiuosius ir šeimas, vaikus, nėščiąsias, vyresnio amžiaus žmones ir žmones su negalia. CareSource taip pat teikia odontologijos, regos, klausos ir vaistinių paslaugas bei COVID-19 pagalbos išteklius. Interneto ir mobilieji įrankiai padeda nariams tvarkyti savo sveikatos priežiūrą.
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Darbai įmonėje

CareSource Director of Claims Process Optimization (Facets)

Lead claims optimization at CareSource, advancing automation and AI across health plan operations. Improve adjudication, financial results, vendor performance, and regulatory readiness.

USJungtinės Valstijos
113 000 $ – 197 700 $ / metai
NuotolinisVisas etatasVadovasPrivaloma Kalba: anglųDirektorius

Aprašymas

  • Lead automation and AI initiatives across claims operations, from design through ongoing oversight.
  • Spot opportunities for intelligent automation, develop business cases, coordinate delivery with configuration, IT, and vendor partners, and verify lasting production results.
  • Oversee claims adjudication and adjustment workflows.
  • Monitor operating budgets and vendor performance.
  • Manage managers, analysts, and process specialists.
  • Account for operating results, including inventory, throughput, auto-adjudication, accuracy, and regulatory turnaround times.
  • Develop and maintain the claims automation and AI roadmap.
  • Measure and report realized benefits against pre-launch baselines.
  • Assess workflows through process maps, time studies, and production data.
  • Make the case for automation and process improvement investments, then report actual results.
  • Monitor cost per claim and capacity use to guide staffing, sourcing, and automation priorities.
  • Set and track budgets for assigned functions and technology initiatives.
  • Lead root cause investigations and work with upstream owners to resolve recurring defects.
  • Maintain procedures, controls, and audit evidence for internal, state, federal, and delegated reviews.
  • Lead daily production, weekly operations, and monthly business reviews.
  • Oversee outsourced, offshore, and technology vendors against service levels, quality requirements, and delivery commitments.
  • Contribute to vendor selection, statements of work, and renewal decisions.
  • Handle other job-related duties as assigned.

Reikalavimai

  • Bachelor's degree in business, health administration, data analytics, or a related field; equivalent relevant work experience may substitute.
  • At least seven years of experience in health plan claims or healthcare operations.
  • At least five years of leadership experience.
  • Practical knowledge of automation and AI applications for claims operations.
  • Working knowledge of claims adjudication platforms, provider reimbursement methods, and coding standards such as CPT, HCPCS, ICD-10, and revenue codes.
  • Strong analytical ability.
  • Demonstrated skill in leading change.
  • Strong financial judgment.
  • Clear written and verbal communication, including presenting technical details and operational risks to executives.
  • Work in a general office setting and be able to sit or stand for extended periods.
  • Travel is generally not required.
  • Salary range of $113,000–$197,700 per year.

Privalumai

  • May be eligible for a bonus based on company and individual performance.
  • Comprehensive total rewards package.
  • Support for employee well-being.
  • Remote work arrangement.

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