Job Title

Employment Type: Full time Shift: Description: This is a temporary, fullu2011time position with an expected duration 08/01/2026 Why MediGold? MediGold ( is a not-for-profit Medicare Advantage insurance plan serving seniors and other Medicare beneficiaries across the United States. Weu2019re dedicated to providing excellent customer service, cost-effective care, and exceptional healthcare coverage. We rely on talented colleagues in a wide variety of professional roles including information technology, financial analysis, audit, provider relations and more. We know that exceptional patient care starts with taking care of our colleagues, so we invest in great people and all that we ask in return is that you come to work ready to make a difference and do the right thing. Position Purpose: The Operations Resolution Specialist researches, analyzes, documents, and coordinates the resolution of escalated and/or complex issues pertaining to claims, member services, network operations and RAPS and EDPS submissions. Serves as a department subject matter expert and requires knowledge of all Plan systems, tools, policies and procedures. What you will do: + Responds to sensitive, escalated and difficult inquiries. Researches, resolves and responds to such inquiries in a timely, compliant and courteous manner. + Determines trends and provides education and feedback related to escalated questions and issues. + Coordinates the identification of root causes for errors and works with multiple operational areas across the Plan to fully resolve identified errors. + Generates reports as necessary to monitor processes. + Assists in the development and maintenance of department policies and procedures. + Functions as a team member by serving as a department resource and subject matter expert + Assists in the development of tools and presentations on documentation, coding, billing, and other requirements necessary for complete encounter data submissions + Works proactively with external vendors to troubleshoot encounter errors and correction of necessary inbound data Minimum Qualifications: + Education: Associate or Bachelor's degree preferred. + Licensure / Certification: Claims department: CPC, CPC-P or equivalent required. Member Services department: Active State of Ohio Insurance License (Life and Health) or obtained within 90 days of hire. Risk Adjustment department: None + Experience: One to three years experience preferred in either managed care health insurance, or customer service disciplines + Knowledgeable in provider coding and billing requirements + Knowledgeable with provider credentialing and contracting terminology + Basic knowledge of the healthcare claims process + General knowledge of current medical terminology, anatomy and physiology Ministry/Facility Information: Mount Carmel, a member of Trinity Health, has been a transforming healing presence in Central Ohio for over 135 years. Mount Carmel serves over 1.3 million patients each year at our five hospitals, free-standing emergency centers, outpatient facilities, surgery centers, urgent care centers, primary care and specialty care physician offices, community outreach sites and homes across the region. Mount Carmel College of Nursing offers one of Ohio's largest undergraduate, graduate, and doctor of nursing programs. If youu2019re seeking a rewarding career where your purpose, passion, and desire to make a difference come alive, we invite you to consider joining our team. Here, care is provided by all of us For All of You We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class. Our Commitment Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.Our Commitment to Diversity and Inclusion Trinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions. Our dedication to diversity includes a unified workforce (through training and education, recruitment, retention, and development), commitment and accountability, communication, community partnerships, and supplier diversity. EOE including disability/veteran