Claims Provider Data Oversight Manager

CareSource

. Oversee and manage enhancement of claim outcomes across existing and emerging lines of business within the Claims organization .

Posted 10/9/2026full-timeRemote • United StatesMid-LevelSenior💰 $83,000 - $132,800 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in provider data management and claims processes, with a strong focus on enhancing claim outcomes and implementing effective solutions. Proficient in project management and data analysis to drive operational efficiency and stakeholder satisfaction.

Highest-signal resume keywords

Facets ExperienceClaims Data ManagementProject ManagementData AnalysisProvider Matching Logic

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims Outcome AnalysisPre-AdjudicationPost-AdjudicationBatch ProcessingRemittance Advice ProcessReimbursement MethodologyWorkflow EvaluationFunctional Requirements DocumentationEnd-to-End TestingData Migration

Soft Skills

Outstanding Written CommunicationOutstanding Verbal CommunicationRelationship ManagementCollaboration SkillsCritical Thinking

Tools & Technologies

Microsoft Office SuiteProject Management Toolsets

Certifications & Qualifications

Project Management Professional (PMP)

Industry Keywords

Healthcare AdministrationClaims ProcessesRegulatory MandatesContractual ObligationsManaged Care Products

Tech Stack

Tools & technologies

PMP

About the role

Key responsibilities & impact

Oversee and manage enhancement of claim outcomes across existing and emerging lines of business within the Claims organization
Define and influence functional requirements for provider matching logic, Facets claim adjudication procedures, provider data loads and management, provider configuration, and end-to-end claims adjudication
Collaboratively influence claim intake, provider match logic, pre-adjudication, adjudication, post-adjudication, payment procedures, and provider data management
Facilitate translation of business requirements into technical solutions with business and technical teams
Partner with Provider Data Management and collaborate with business, architecture, and infrastructure teams to uphold service levels and stakeholder satisfaction
Lead implementation of provider data management for appropriate claim outcomes in new and existing lines of business
Identify system enhancements, provider matching logic opportunities, and data migration requirements; perform end-to-end testing when applicable
Analyze data, workflows, policies, and procedures and propose solutions for growth initiatives
Oversee provider data management process analysis; develop, document, and communicate functional requirements
Conduct data analysis, workflow evaluations, and policy assessments to refine provider data loads, improve operational efficiency, and resolve complex technology and process challenges
Organize work teams, drive consensus, establish project plans, facilitate meetings, and document recommendations and decisions
Ensure adherence to industry best practices, regulatory mandates, and contractual obligations
Foster continuous improvement of provider data management and claims processes
Drive cross-functional oversight of provider loads and accurate application of business requirements and provider matching logic
Perform other duties as requested

Requirements

What you’ll need

Bachelor's degree in business administration, healthcare administration, or a related field, or equivalent years of relevant work experience is required
Minimum of three (3) years of progressive experience in provider record data, claims data management, or a related field, including claims outcome analysis, is required
Facets experience is required
Project management experience is required
Proficiency in Microsoft Office suite
Proven track record of successfully implementing new managed care products
Ability to manage various complex projects and processes to completion
Expert understanding of claims processes, Facets, pre-adjudication, post-adjudication, Checkwrite, Mass Claims Adjustments, Batch Processing, Remittance Advice process, reimbursement methodology, and project management toolsets
Outstanding written and verbal communication skills
Strong relationship management and collaboration skills
Effective listening and critical thinking skills
Strong analytical and problem-solving abilities
Project Management Professional (PMP) certification preferred
General office environment; may be required to sit or stand for extended periods of time
Occasional travel may be required based on business needs

Benefits

Comp & perks

Bonus tied to company and individual performance may be available
Substantial and comprehensive total rewards package
Equal Opportunity Employer fostering an environment of belonging that welcomes and supports individuals of all backgrounds