Senior Associate, Member Claim Processing

This is a fully remote position, open to applicants in United States.

📋 Description

• Oversee the operational execution of member claim processing for the Medicare Advantage sector within the organization.

• Manage daily member claim processing, including handling complex, escalated, and non-standard claims personally.

• Track queue inventory, aging, and turnaround times to meet service level obligations.

• Proactively resolve bottlenecks before they escalate into compliance issues and notify the manager of potential risks.

• Follow standard operating procedures (SOPs) and escalate complex cases that require further clarification.

• Collaborate with Claims Operations, Configuration, and Technology leadership to identify the root causes of processing errors and necessary rework.

• Assist in preventing processing defects through the establishment of feedback loops.

• Aid in processing member claim appeals and cases related to member claims.

⛳️ Requirements

• Highly organized with a keen eye for detail and the capability to understand and document critical information.

• Proficient in accurately and swiftly processing claims.

• Possess conversational agility, including the ability to reframe, refocus, and steer discussions to achieve intended results.

• Capable of simplifying complex concepts into straightforward explanations with clear and concise calls to action.

• Strong writing skills to create thoughtful, clear, persuasive, accurate, plain-language, and tailored communications for members.

• Proven experience in building and maintaining process documentation that withstands audits.

• Bachelor's degree or equivalent work experience is mandatory.

• Preferred experience in healthcare, healthcare technology, or tech operations.

• Familiarity with Medicare Advantage claims adjudication, member reimbursement, or CMS timeliness requirements is advantageous.

• Ability to excel in a fast-paced startup environment.

• Capable of maintaining high throughput while working both autonomously and collaboratively.

• Demonstrated ability to become an expert in unfamiliar tools or systems.

• Preferred experience with data, analytics, and business intelligence platforms such as Snowflake or Looker.

🏝️ Benefits

• Employer-sponsored health, dental, and vision plans with low or no premiums.

• Generous paid time off policy.

• $100 monthly stipend for mobile or internet expenses.

• Stock options available to all employees.

• Bonus eligibility for all roles, excluding Director and above.

• Commission eligibility for Sales positions.

• Parental leave program.

• 401K program.