Senior Associate, Member Claim Processing

Job not on LinkedIn

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $58k - $82k / year

⏰ Full Time

🟠 Senior

👻 Ghost score 0%

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Devoted Health

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2017

🏥 Healthcare

⚕️ Healthcare Insurance

🧘 Wellness

Healthcare • Healthcare Insurance • Wellness

Devoted Health is a healthcare company that offers Medicare Advantage plans designed to provide comprehensive health coverage with added benefits like dental, eyewear, gym memberships, and prescription drugs at competitive rates. The company emphasizes member support and service, ensuring that clients can easily navigate their benefits and access needed healthcare services. Devoted Health is committed to helping customers save money and enhance their health and wellness through a complete package of benefits and support.

📋 Description

• Lead the organization's operational execution of member claim processing for the Medicare Advantage business • Own day-to-day member claim processing, including personally completing complex, escalated, and non-standard claims • Monitor queue inventory, aging, and turnaround time against service level requirements • Clear bottlenecks before they become compliance risks and escalate risks to the manager • Adhere to SOPs and escalate complex scenarios requiring clarification • Partner with Claims Operations, Configuration, and Tech leadership to identify root causes of processing errors and rework • Help prevent processing defects through feedback loops • Support processing member claim appeals and member claim cases

🎯 Requirements

• Super organized with an eye for detail and the ability to understand and document what matters • Ability to process claims accurately and quickly • Conversational agility, including the ability to reframe, refocus, and redirect conversations to achieve desired outcomes • Ability to condense complex concepts into simple explanations with clear and concise calls to action • Strong writing ability to craft thoughtful, clear, persuasive, accurate, plain-language, and tailored member communications • Track record of building and maintaining process documentation that holds up under audit • Bachelor's degree required, or equivalent work experience • Experience in healthcare, healthcare technology, or tech operations preferred • Experience with Medicare Advantage claims adjudication, member reimbursement, or CMS timeliness requirements preferred • Ability to thrive in a fast-paced startup environment • Capacity for high throughput while working autonomously and collaboratively • Track record of becoming an expert with an unfamiliar tool or system • Experience with data, analytics, and business intelligence platforms such as Snowflake or Looker preferred

🏖️ Benefits

• Employer sponsored health, dental and vision plan with low or no premium • Generous paid time off • $100 monthly mobile or internet stipend • Stock options for all employees • Bonus eligibility for all roles excluding Director and above • Commission eligibility for Sales roles • Parental leave program • 401K program