AllCare Health

People Operations

• Partner with the VP of People & Culture and leadership team to shape and strengthen people practices across AllCare Health
• Support development and implementation of strategic People & Culture plans and policies
• Oversee People & Culture operations and ensure compliance with labor laws
• Analyze People & Culture effectiveness and provide specialized reports to the VP of People & Culture
• Serve as a member of the Senior Leadership Team
• Manage labor and employee relations, employee safety, Workers' Compensation, and People & Culture policies and procedures
• Develop and deliver plans, policies, and initiatives covering recruitment, training, and compensation
• Collaborate on payroll, benefits, incentives, employee engagement, employee retention, talent acquisition, and related functions
• Assist with workforce planning, organizational effectiveness, and change management initiatives
• Monitor employee progress toward career paths or job designations
• Promote equal opportunity and diversity
• Monitor policies and department functions for compliance with government regulations and public policy
• Coordinate between staff and management and resolve workplace conflicts
• Collaborate with health and safety to manage Workers' Compensation, OH&S policies, workplace health and safety plans, and risk assessment
• Assist with recruitment efforts and develop talent acquisition strategies
• Maintain regular attendance and work collaboratively in a team environment
• Perform other duties as assigned

Director, People & Culture

Claims Specialist

• Independently adjudicate professional CMS-1500 claims using benefits, pricing, coding guidelines, and contract terms
• Apply CPT, HCPCS, ICD-10 coding, benefit plans, and contract language to determine claim outcomes, pricing, payments, and denials
• Review and resolve pending claims, edits, denials, adjustments, and reprocessing requests
• Analyze claim and line-level data to identify coding discrepancies, system configuration issues, policy misalignment, eligibility discrepancies, authorization requirements, and billing errors
• Coordinate benefits by reviewing member eligibility, other insurance information, and payer responsibility
• Review provider disputes, reconsiderations, and appeals and determine whether reprocessing or adjustment is warranted
• Apply reimbursement methodologies, fee schedules, and pricing logic
• Identify recurring claim-processing issues and escalate findings to leadership
• Communicate with internal teams and providers to clarify claim details and resolve processing issues
• Maintain HIPAA and PHI confidentiality and security
• Follow claim routing, inventory control, and workflow procedures
• Participate in ongoing training and continuing education
• Meet productivity, quality, turnaround-time, attendance, and production standards
• Take direction from Department leadership and perform other duties as assigned
• No on-call or supervisory responsibilities

Director, People & Culture

Certified Claims Processor I