Care Operations Specialist

About the role

The Care Operations Specialist supports the day-to-day operational execution of our care programs, ensuring a high-quality experience for members and internal partners. Key responsibilities include case placement analysis, cost share review, and savings analysis.

Responsibilities

• Execute day-to-day operational work in support of 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

Requirements

• 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; willing to ask questions, speak up, and seek clarity when needed
• Willingness to be flexible and support urgent operational needs

Qualifications

• Familiarity with CPT and DRG surgical codes
• 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

Skills

• Strong analytical and problem-solving skills
• Highly organized and detail-oriented
• Comfortable working independently and as part of a team
• Results-oriented
• Excellent interpersonal and communication skills

Benefits

• Competitive medical, dental, and vision coverage
• 401(k) Plan with a generous company match
• Flexible Time Off/Paid Time Off, 13 paid holidays
• Protection Plans including Life Insurance, Disability Insurance, and Supplemental Insurance
• Mental Health and Wellness benefits

Pay

Individual compensation packages are based on a few different factors unique to each candidate, including primary work location and an evaluation of a candidate’s skills, experience, market demands, and internal equity. Salary is just one component of Transcarent's total package.

Schedule

Regular employees are also eligible for the corporate bonus program or a sales incentive (target included in OTE).