Jackson Healthcare
Risk & Claims Operations Specialist
Alpharetta-Georgia · Contract
Sponsorship not specifiedDetected 30 days ago
Data AnalysisExcelOperations ManagementProcess ImprovementPatient CareLeadershipCommunicationCollaborationPublic SpeakingMicrosoft OfficeMicrosoft TeamsSharePointClaims Management
About the role
- Headquartered in metro Atlanta, we're powered by more than 2,600 associates and over 20,000 clinician providers covering all 50 U.S. states.
- Our mission is to improve the delivery of patient care and the lives of everyone we touch.
- We're always looking to add new talent to our teams.
Responsibilities
- Manage the daily intake and completion of provider Risk Reviews within established deadlines
- Monitor exception queues and manage the review and confirmation of flagged claims before responses are issued
- Maintain organized, audit-ready records and ensure process consistency across all verification activity
- Track enrollment status, manage time-sensitive deadlines, and proactively communicate updates to all relevant stakeholders
- Maintain accurate documentation throughout the enrollment lifecycle to support audit readiness and compliance
- Build and maintain Excel-based tracking tools including pivot tables, charts, and VLOOKUPs
- Analyze operational data to surface insights and support informed decision-making across the enterprise
Requirements
- 7+ years of experience in process improvement, operations management, or cross-functional coordination
- Advanced Microsoft Excel (required) - pivot tables, VLOOKUPs, charts, and data analysis
- Evaluate escalated provider files using Microsoft Teams, SharePoint, VComm, MDStaff, and Outlook, applying preestablished guidelines and criteria to assess flagged exceptions - clinical expertise is not required
- The ability to earn trust, communicate clearly, and demonstrate consistent value is just as important as technical skill.
- the ability to see and embrace these as productivity enablers rather than disruptions
- Evaluate escalated provider files using Microsoft Teams, SharePoint, VComm, MDStaff, and Outlook, applying preestablished guidelines and criteria to assess flagged exceptions - clinical expertise is not required; sound judgment and process discipline are
Nice to have
- Bachelor's degree preferred, ideally in Risk Management, Operations, Business, or a related field
- high school diploma or equivalent required
- Comfort engaging with multiple platforms and systems
- experience with workflow mapping is a plus
Compensation
- Conduct annual audits comparing providers paid vs. Risk Reviews completed, analyzing year-over-year trends and reporting on gaps or process breakdowns
Benefits
- Jackson Healthcare's core business is placing physicians, nurses, and other healthcare providers in clinical settings across the United States on a short-term basis.
- Communicate findings and approval status to company representatives across the Jackson Healthcare family in a clear, timely, and professional manner
Company info
- We are looking for someone who asks "why do we do it this way?" - and then does something about it.
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This listing is sourced directly from Jackson Healthcare's careers page and normalized into a canonical job model.