Note: The job is a remote job and is open to candidates in USA. Transcarent is a health and care company that brings medical, pharmacy, and point solutions together through its WayFinding health and care platform. The Care Operations Specialist executes day-to-day care program operations, including case placement analysis, cost share reviews, savings analysis, and claims-related reviews. The role collaborates with clinical, billing, and operations partners to resolve issues and ensure accurate, compliant, and timely workflows.
Responsibilities
- Execute day-to-day operational work in support of our care programs, ensuring timely, accurate, and compliant completion of assigned deliverables
- Assist with case placement analysis by reviewing cases against plan rules, requirements, and internal guidelines
- Perform cost share reviews to support accurate member-facing and internal operational decisions
- Complete tickets and supporting work related to savings analysis
- Partner closely with the Care Support Services team to help manage workload and maintain turnaround times
- Collaborate with internal clinical, billing, and operations partners to resolve questions, issues, escalations, and delays
- Review data, claims details, and supporting documentation to identify discrepancies or items requiring follow-up
- Document findings clearly and escalate non-standard situations when appropriate
- Follow established policies, procedures, and workflows while maintaining a high level of detail and accuracy
Skills
- • Bachelor's degree in healthcare, business, or a related field, or equivalent relevant experience
- • 3+ years of experience in healthcare operations, medical billing, revenue cycle, claims review, or a related operational role
- • Strong analytical and problem-solving skills, with the ability to review detailed information and make sound decisions
- • Highly organized and detail-oriented, with the ability to manage multiple tasks and priorities
- • Comfortable working independently and as part of a team, with minimal direct supervision
- • Results-oriented, with experience meeting productivity, quality, and turnaround expectations
- • Excellent interpersonal and communication skills; willingness to ask questions, speak up, and seek clarity when needed
- • Comfortable in a fast-paced and evolving organization with a willingness to be flexible and support urgent operational needs
- • Clinical experience
- • Familiarity with CPT and DRG surgical codes
- • Medical billing experience, including cost share review experience
- • Experience working with providers, carriers, TPAs, or other healthcare stakeholders
- • Experience supporting operational workflows that require review of claims, coding-related information, or reimbursement details
Benefits
- All regular employees are eligible for the corporate bonus program or a sales incentive (target included in OTE)
- All regular employees are eligible for stock options
- Competitive medical, dental, and vision coverage
- Competitive 401(k) Plan with a generous company match
- Flexible Time Off/Paid Time Off
- 13 paid holidays
- Life Insurance
- Disability Insurance
- Supplemental Insurance
- Mental Health and Wellness benefits
Company Overview