Managed Care Specialist
 UNC Health Care | |
$23.24 - $33.41 per hour
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 United States, North Carolina, Morrisville | |
| 5221 Paramount Parkway (Show on map) | |
 Mar 13, 2026 | |
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Description Become part of an inclusive organization with over 40,000 teammates, whose mission is to improve the health and well-being of the unique communities we serve. About the Role We are seeking a detailoriented and analytical Managed Care Specialist to review physician claims and ensure payments are made according to negotiated contractual terms. In this role, you will investigate underpaid claims, analyze payer adjudication, and determine the root cause of payment discrepancies - whether from payer errors, contract interpretation issues, or internal setup problems. You will validate expected reimbursement against fee schedules, carrier policies, and contract requirements to determine next steps for resolution. You will perform indepth research and manual reimbursement calculations as needed to verify claim accuracy. This includes applying complex contract terms, reviewing payer processing logic, and identifying patterns or trends that affect proper reimbursement. Clear documentation of findings and organized recordkeeping are essential components of the role. A key responsibility of the Managed Care Specialist is engaging directly with insurance carriers to correct underpayments. You will follow up via phone, online portals, or written inquiries to request claim adjustments or reprocessing. Persistent tracking and follow-through are crucial to ensuring accurate adjudication and timely resolution. Collaboration is central to this position. You will work closely with team members to share insights, assist with complex cases, and support the department's continuous improvement efforts. You will also be partnering with internal departments and external payer representatives while maintaining a professional and respectful communication style. Additionally, you will assist in auditing complex or highvalue claims and documenting outcomes in accordance with internal policies and payer guidelines. What We're Looking For * Strong analytical and critical-thinking skills * Experience reviewing claims or working with payer reimbursement (preferred but not required) * Ability to read, understand, and apply managed care contract terms * Skills for interacting with payer representatives * Strong attention to detail and high accuracy in calculations * Ability to work independently and collaboratively Why Join Us? * Opportunity to work in a collaborative, supportive team environment * Meaningful work that helps ensure fair and accurate reimbursement for services provided * Professional growth in managed care, finance, or revenue cycle operations Other Information Other information: Job Details Legal Employer: NCHEALTH Entity: Shared Services Organization Unit: Managed Care Work Type: Full Time Standard Hours Per Week: 40.00 Salary Range:$23.24 - $33.41 per hour (Hiring Range) Pay offers are determined by experience and internal equity Work Assignment Type: Remote Work Schedule: Day Job Location of Job: US:NC:Morrisville Exempt From Overtime: Exempt: Yes This position is employed by NC Health (Rex Healthcare, Inc., d/b/a NC Health), a private, fully-owned subsidiary of UNC Health Care System, in a department that provides shared services to operations across UNC Health Care; except that, if you are currently a UNCHCS State employee already working in a designated shared services department, you may remain a UNCHCS State employee if selected for this job. Qualified applicants will be considered without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, status as a protected veteran or political affiliation. | |