What are the responsibilities and job description for the Operations Specialist position at IntePros?
We are seeking a highly analytical and detail-oriented Operations Specialist to join our Accumulators team. This role focuses on reconciling medical and pharmacy (Rx) claims, monitoring deductibles and out-of-pocket expenses, and ensuring accurate data sharing between internal systems and external pharmacy vendor partners. The ideal candidate will have strong problem-solving skills, a keen eye for detail, and the ability to collaborate with multiple departments to resolve issues efficiently.
Key Responsibilities:
- Audit, analyze, and reconcile accumulator data between medical and pharmacy claims.
- Identify and resolve discrepancies in deductibles and out-of-pocket maximums.
- Investigate root causes of claim-related issues and work with business and technology teams to implement solutions.
- Monitor system health and data feeds, researching discrepancies through tools like HealthRules and HealthProof.
- Serve as a liaison between internal teams (sales, benefits, claims) and external pharmacy vendor partners.
- Process and resolve tickets related to accumulator and claim discrepancies, ensuring timely resolution.
- Validate claims reporting, encounter data files, and accumulator files.
- Continuously seek opportunities for process automation and efficiency improvements.
- Support compliance efforts by ensuring accurate claims processing and reporting.
Qualifications & Skills:
- Education: Bachelor’s degree in Accounting, Computer Science, Information Systems, or a related field preferred.
- Experience: 2-3 years in healthcare operations, claims processing, or a related role.
- Strong skills in Microsoft Excel (VLOOKUPs, pivot tables).
- Experience with SQL Server (writing queries and analyzing data).
- Familiarity with HealthRules and HealthProof is a plus.
- Highly detail-oriented, capable of reviewing numbers and claims at a granular level.
- Observant and proactive in identifying discrepancies and finding solutions.
- Comfortable working in a fast-paced, deadline-driven environment.
- Ability to work cross-functionally with internal teams and external partners.
- Strong interpersonal skills for effectively engaging with sales, benefits, claims, and technology teams.
This is an excellent opportunity for someone with a background in healthcare operations, accounting, or computer science who is passionate about data accuracy, process improvement, and automation. If you thrive in a problem-solving environment and enjoy working with claims data, we encourage you to apply!
Salary : $38 - $40
