About this role
The Medicare Operations Claims team reviews and resolves Medicare claims processing questions and issue requests. This includes conducting comprehensive analyses, assessing impact, and implementing appropriate remediation at both the individual claims and plan levels. The Operations Specialist Senior will report to the Claims Operations Director. In this role you will identify claims processing issues, perform root cause analysis, and provide remediation based on findings. You will also work independently and collaboratively with internal teams to develop solutions that improve operational efficiency while ensuring compliance with state, federal, and local policies and provisions.