Cost Containment Specialist

4 weeks ago


Aurora, United States UNITE HERE HEALTH Full time
Job DescriptionJob Description


UNITE HERE HEALTH serves 190,000+ workers and their families in the hospitality and gaming industry nationwide. Our desire to be innovative and progressive drives us to develop impactful programs and benefits designed to engage our participants in managing their own health and healthcare. Our vision is exciting and challenging. Please read on to learn more about this great opportunity

The Cost Containment Specialist position will support Claims and the automation of the high dollar claim review process. This role would be a liaison between the Claims Department and our networks and vendors, ensuring all information is received and reviewed within outlined timeframes for high-dollar claims that meet the defined criteria.

ESSENTIAL JOB FUNCTIONS AND DUTIES

  • Coordinates with the Claims Support team once medical records are received from the networks
  • Requests medical records from networks if they are not received timely
  • Submits medical records and all pertinent information to Medical Management and/or Claim review vendors
  • Tracks the status of all submitted cases to vendors to ensure timelines are met
  • Follows up with vendors if claims are approaching the deadline
  • Coordinates meetings with vendors and Medical Management as needed
  • Adjudicates corrected claims according to the plan benefit designs
  • Evaluates diagnoses, procedures, services, and other submitted data to determine the need for further investigation related to benefit requirements, the accuracy of the claim filed, and the appropriateness or frequency of care rendered
  • Establishes and maintains relationships with key stakeholders to ensure the successful completion of high dollar claims under review.
  • Offers suggestions on process improvement initiatives by identifying patterns and/or trends
  • Generates and provides regular status reports of high-dollar claims, including trends, challenges, and outcomes to the Leadership team
  • Assists with claims-related projects and reporting as needed

ESSENTIAL QUALIFICATIONS

  • 4 ~ 6 years of related experience in a medical claim adjudication environment, or 3 years in a health care or insurance environment
  • Working knowledge and experience interpreting benefit plans, including an understanding of limitations, exclusions, and schedule of benefits
  • Experience with eligibility verification, medical coding, coordination of benefits, and subrogation
  • Experience with medical terminology, International Classification of Diseases (ICD)10 and Current Procedures Terminology (CPT) codes
  • Bachelor's degree in Health Care Administration or related field or equivalent work experience required
  • Preferred: AAPC or AHIMA Certification

Hourly range for this position: $24.61~$30.15. Actual hourly rate may vary based upon, but not limited to: relevant experience, qualifications, expertise, certifications, licenses, education or equivalent work experience, time in role, peer and market data, prior performance, business sector, and geographic location.

Work Schedule (may vary to meet business needs): Monday~Friday, 7.5 hours per day (37.5 hours per week) with potential for hybrid work-from-home arrangement.

We reward great work with great benefits, including but not limited to: Medical, Dental, Vision, Paid Time-Off (PTO), Paid Holidays, 401(k), Pension, Short- & Long-term Disability, Life, AD&D, Flexible Spending Accounts (healthcare & dependent care), Commuter Transit, Tuition Assistance, and Employee Assistance Program (EAP).

#LI-Remote



  • Aurora, United States UNITE HERE HEALTH Full time

    Job DescriptionJob DescriptionUNITE HERE HEALTH serves 190,000+ workers and their families in the hospitality and gaming industry nationwide. Our desire to be innovative and progressive drives us to develop impactful programs and benefits designed to engage our participants in managing their own health and healthcare. Our vision is exciting and challenging....


  • Aurora, United States Unite Here Health Full time

    Looking for a way to influence the health and healthcare of many? If so, we'd love to hear from you! Our mission-driven organization is focused on the "Triple Aim" - Better Health, Better Healthcare and Lower Costs to individuals and their families who participate in our health plans. UNITE HERE HEALTH serves 190,000+ workers and their families in the...

  • Logistics Specialist

    3 weeks ago


    Aurora, United States Safilo USA Full time

    Job DescriptionJob DescriptionGeneral Summary:This position is pivotal in managing and optimizing our logistics operations, ensuring the seamless and cost-effective flow of goods from the vendor to the distribution center. The Logistics Specialist will be the key player, coordinating with various departments and managing transportation. The ideal candidate...


  • Aurora, United States Safilo USA Full time

    Job DescriptionJob DescriptionGeneral Summary:This position is pivotal in managing and optimizing our logistics operations, ensuring the seamless and cost-effective flow of goods from the vendor to the distribution center. The Logistics Specialist will be the key player, coordinating with various departments and managing transportation. The ideal candidate...

  • Safety Specialist

    4 weeks ago


    Aurora, United States Kimbel Mechanical Systems Full time

    Job DescriptionJob DescriptionSafety Specialist Purpose: As a Safety Specialist you will monitor and inspect construction sites to ensure compliance to laws and regulations related to applicable licensing ratios, codes, and specifications.Responsibilities:Inspect and monitor construction sites to ensure adherence to safety standards, licensing ratios,...

  • Safety Specialist

    4 weeks ago


    Aurora, United States Kimbel Mechanical Systems Full time

    Job DescriptionJob DescriptionSafety Specialist Purpose: As a Safety Specialist you will monitor and inspect construction sites to ensure compliance to laws and regulations related to applicable licensing ratios, codes, and specifications.Responsibilities:Inspect and monitor construction sites to ensure adherence to safety standards, licensing ratios,...


  • Aurora, United States INEOS Styrolution America LLC Full time

    **Job Opportunity** **Reporting & Accounting Process Specialist I** **Aurora, Illinois** United States (US)* **INEOS Styrolution America LLC** **We Have Great Chemistry** We believe diversity is perceiving difference; inclusion is valuing it. Without inclusion, we cannot unlock the value that diversity has to offer. Everyone has a seat at our company table....


  • Aurora, United States Illinois Department of Children and Family Services Full time

    Location: Aurora, IL, US, 60506 Job Requisition ID: 38500 **DCFS is deeply committed to the welfare and protection of children. Our goal is to protect children by strengthening and supporting families. In every effort, from receiving hotline calls to reaching family reunification or foster care and adoption, children and families are our...


  • Aurora, United States DBSI Services Full time

    Job DescriptionJob DescriptionJob Title: Hydraulic Sealing SpecialistLocation: Aurora, IllinoisJob Duties/Responsibilities may include, but are not limited to:Design responsibility for hydraulic sealing products across the enterprise; accountable for meeting customer expectations for product cost, quality, and delivery (for example)Contribute to multiple New...


  • Aurora, United States DBSI Services Full time

    Job DescriptionJob DescriptionJob Title: Hydraulic Sealing SpecialistLocation: Aurora, IllinoisJob Duties/Responsibilities may include, but are not limited to:Design responsibility for hydraulic sealing products across the enterprise; accountable for meeting customer expectations for product cost, quality, and delivery (for example)Contribute to multiple New...


  • Aurora, United States Talent Acquisition Concepts Full time

    Salary Range: $50k - $65kWhat does a typical day look like for theContract Support Specialist * ?* Perform acquisition planning, solicit, evaluate, negotiate, analyze, advise, and assist with contract awards Perform post-award administration and terminations on contracts for the procurement of supplies and services (including complex contracts and high...


  • Aurora, United States HCA Full time

    Hourly Wage Estimate: $29.42 - $46.14 / hour Learn more about the benefits offered for this job. The estimate displayed represents the typical wage range of candidates hired. Factors that may be used to determine your actual salary may include your specific skills, how many years of experience you have and comparison to other employees already in this...

  • Licensing Specialist

    3 weeks ago


    Aurora, United States American Financing Full time

    At American Financing, we're innovators with imagination. We do what it takes to help customers achieve their financial goals. And we stay ahead of the competition by challenging ourselves to become more efficient. We are one of the fastest-growing national mortgage lenders because we don't follow the status quo. See what it's like to work for a national...

  • Recoup Specialist

    2 weeks ago


    Aurora, Illinois, United States Shamrock Foods Full time

    Pay: $22/HR Full-Time: 5 days a week with split days off/ Sunday + one other day between Monday-Thursday Schedule: 6:00 AM-2:30 PM Summary: The Recoup Specialist will be responsible for inspecting, documenting, and managing damaged food products within the distribution center. Your attention to detail, organizational skills, and ability to collaborate with...


  • Aurora, Colorado, United States Army National Guard Full time

    Job Description:Job DescriptionLooking for a job in aviation? Join the Army National Guard as an Aviation Operations Specialist and watch your skills and abilities soar In this role, you will help operate one of the largest fleets of aircraft in the world by keeping accurate and detailed flight information records for both flight and ground crews. Through...


  • Aurora, Colorado, United States Army National Guard Full time

    Job Description:Job DescriptionLooking for a job in aviation? Join the Army National Guard as an Aviation Operations Specialist and watch your skills and abilities soar In this role, you will help operate one of the largest fleets of aircraft in the world by keeping accurate and detailed flight information records for both flight and ground crews. Through...


  • Aurora, United States Army National Guard Full time

    Job Description:Job DescriptionLooking for a job in aviation? Join the Army National Guard as an Aviation Operations Specialist and watch your skills and abilities soar! In this role, you will help operate one of the largest fleets of aircraft in the world by keeping accurate and detailed flight information records for both flight and ground crews. Through...


  • Aurora, United States State of Illinois Full time

    **DCFS is deeply committed to the welfare and protection of children. Our goal is to protect children by strengthening and supporting families. In every effort, from receiving hotline calls to reaching family reunification or foster care and adoption, children and families are our focus.** **Agency**: Department of Children and Family Services **Title**:...


  • Aurora, United States Wagner International LLC Full time

    Would you like to be part of a focused, dedicated team? Do you want to work and grow with other motivated, ambitious people? Wagner Equipment Co. offers challenging career opportunities, extensive training and employee development along with an opportunity to grow your career and thrive under Wagner's reputation for excellence. We offer excellent benefits...


  • Aurora, United States American Financing Corp Full time

    Job DescriptionJob DescriptionAt American Financing, we're innovators with imagination. We do what it takes to help customers achieve their financial goals. And we stay ahead of the competition by challenging ourselves to become more efficient. We are one of the fastest-growing national mortgage lenders because we don't follow the status quo.See what...