OPEN POSITIONS
Claims Process Expert (Healthcare) - Contractor
REQUIREMENTS
Location: Indianapolis, IN – this position is a hybrid position but needs to be located in central Indiana to be onsite with partners as needed.
Summit Managed Solutions partners with healthcare organizations to help them solve their most complex problems. Part strategy consulting, part tech-enabled professional services, our team is a diverse mix of experienced problem solvers who work with partners to create innovative solutions with enduring value.
JOB SUMMARY
We are seeking a Claims Process Expert (Contractor) to serve as a subject matter expert in Medicaid claims processing, data analysis, and operational workflow optimization. This role is responsible for evaluating and improving claims-related processes, ensuring data quality and compliance with regulatory requirements, and supporting cross-functional teams with insights and reporting. The Claims Process Expert will play a critical role in identifying inefficiencies, developing innovative solutions, and ensuring that claims operations run smoothly, accurately, and in alignment with state requirements.
We are seeking an individual who exhibits a high level of professionalism, a passion for innovation, and a business style that is scrappy, strategic, creative, team-oriented, hands-on, and collaborative.
What You'll Do:
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Research and resolve workflow issues, system irregularities, and process gaps within claims operations
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Analyze claims data to identify trends, root causes, and opportunities for operational improvements
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Develop, test, and implement process enhancements, including automation and data quality controls
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Create and manage queries, reports, and dashboards to monitor claims performance and identify anomalies
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Define, plan, and deliver on items that require cross-functional collaboration between different teams and/or related activities
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Lead and manage project plans related to process improvements, new system implementations, and new account integrations
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Ensure compliance with state regulations by applying knowledge of claims lifecycle and encounter submissions
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Communicate complex data findings and process recommendations clearly to both technical and non-technical stakeholders
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Represent the department in business process meetings, advocating for claims integrity and efficiency
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Support Summit’s process for delivering value at every partner interaction, and be able to adapt style to build strong partner relationships
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Support Summit leadership in documenting processes to create repeatable, scalable programs and initiatives
What You'll Need:
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Bachelor’s degree in Business, Healthcare Administration, Data Analytics, or a related field (or equivalent work experience)
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3 - 5+ years of experience in claims operations, process improvement, or data analysis (Medicaid or healthcare insurance experience strongly preferred).
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Strong knowledge of the Medicaid claims lifecycle, adjudication processes, and regulatory requirements.
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Proven experience with data analysis and reporting tools (SQL, Power BI, SAS, or similar).
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Deep passion for process improvement, innovation, and patient-facing programs
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Proven thought leader with intellectual curiosity and superior ability to use reason, logic, and creativity to solve ambiguous problems
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Demonstrated ability to manage through change and willingness to take on work, at times, outside of defined role to support small business team dynamic
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Skilled communicator who is comfortable, effective, and influential in meetings with senior management teams
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Self-starter who can thrive in an unstructured and collaborative team environment
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Ability to be onsite with partners in Indianapolis as needed
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Ability to travel occasionally throughout the year
What we offer:
This is a Contractor position. You will act as an independent Contractor, therefore no benefits are provided. Individual rates for this role will depend on a variety of factors including qualifications, skills and applicable laws. Up to 40 hours per week.
If you are passionate about making a positive impact in healthcare, we encourage you to apply and become an extension of our team!
EQUAL OPPORTUNITY EMPLOYER
Summit Managed Solutions is an equal opportunity employer, and we value diversity at our company. We do not just accept diverse backgrounds, we celebrate them. Our company, the work we do, and our partners benefit from the value of a diverse team. No team member's value lies alone in their diversity, and because we value diversity so highly, we reiterate that all hiring and employment decisions are made on merit, performance, competence, and business needs. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.
OUR PARTNERS
We work with healthcare organizations that are entrusted to positively impact the lives of those they serve. Our partners span the private, public, and social sectors and include large insurance companies, health systems and providers, governments, non-profits, and healthcare technology companies.
WHAT WE VALUE
WE TAKE INITIATIVE
We have a bias for action. We make decisions with imperfect information and quickly move forward. We are comfortable with discomfort. We learn, we iterate, and we progress.
WE IMPACT
We have exceptionally high standards and strive to add value through all interactions. We seek, uncover, and speak truth. We measure our success in terms of what we build for partners.
WE INNOVATE
We dream big and we lead through vision. We challenge the status quo and push boundaries. We’re optimists who ignite positive transformations.
ABOUT INDIANA MEDICAID
Medicaid is a health program that provides insurance and benefits for specific populations in the US. The Federal government establishes general guidelines for the administration of Medicaid benefits. Individual states are charged with administering Medicaid so eligibility requirements and the type and scope of services provided can vary by state.
In Indiana, there are 4 main Medicaid programs: Healthy Indiana Plan (HIP), Hoosier Healthwise (HHW), Hoosier Care Connect (HCC), and PathWays. HIP covers Indiana residents ages 19 to 64 who meet specific income levels. HHW covers children up to age 19 and pregnant women. HCC covers individuals who are aged 65 years and older, blind, or disabled and who are also not eligible for Medicare. PathWays will launch in 2024 and covers Hoosiers aged 60 and over who receive Medicaid (or Medicaid and Medicare) benefits.
The state of Indiana contracts the administration of its Medicaid programs (a term known as Managed Care) to insurance companies like Elevance Health (formerly known as Anthem), Humana, CareSource, MDwise, UnitedHealthcare, and others. These insurance companies are responsible for ensuring the care of their members and do way more than just process claims and provide a network of doctors and hospitals. These companies also ensure members have reliable transportation to appointments, have access to healthy food, educate youth on the importance of annual physicals, provide nurse case managers to members with chronic illnesses, provide member resources for stable housing, convene events and celebrations in communities, collaborate with professional sports teams to raise awareness of health issues, coordinate in-home care, deliver dental hygiene kits to churches, implement telemedicine solutions to help those living in rural areas, guide first-time-mothers through their pregnancy journey, and the list goes on!