Senior Claims Benefit Configuration Associate

Job not on LinkedIn

🔥 1 minute ago

🇺🇸 United States – Remote

💵 $58k - $96k / 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

• Oversee all aspects of claims benefit setup, analysis, mapping, testing, troubleshooting, and implementation • Ensure accurate configuration of member cost share, benefit limitations, and provider payment information • Act as a liaison across departments regarding benefit and claims processing • Support interpretation, analysis, implementation, and audit of claims configuration, including benefits, authorization, denial library, CMS billing and coding guidelines, and Devoted payment policies • Manage the claims benefit configuration inbox and respond to stakeholder questions while maintaining turnaround times and response quality • Develop, implement, and enforce quality control procedures for claims configuration • Perform routine reviews to enhance configuration accuracy and performance • Lead end-to-end 1/1 annual readiness for benefit configuration and BID application management • Establish project timelines, maintain documentation, and facilitate cross-functional alignment with MedProduct, Clinical, and Claims teams • Oversee the Devoted Denial Reasons library and ensure accurate mapping of internal denial codes • Identify, design, and implement process improvements to scale configuration operations, reduce error rates, and streamline cross-team execution

🎯 Requirements

• Proven experience analyzing data sets to generate insights and turn those insights into action • Strong analytical and problem-solving skills • Fluency in google-sheets/excel • Ability and desire to learn new tools • Experience working with data analytics team on more involved data asks • Strong organizational skills and experience managing high-impact workflows with compressed timelines • Excellent communication and collaboration skills for working with cross-functional teams • Exceptional organizational skills, adept at prioritizing tasks effectively to consistently meet deadlines • Thrives in a fast paced, metrics driven environment and is comfortable with ambiguity • Some knowledge of health insurance claims processing, regulations, and compliance requirements • Certified professional coder (CPC) is a plus • Experience collaborating with offshore resources or distributed teams, with the ability to clearly communicate priorities and task requirements without direct managerial authority • Experience applying AI and automation to reduce manual operational work • Bachelor’s degree is desired; relevant professional experience will be considered in lieu of a bachelor's degree

🏖️ 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