Senior Claims Benefit Configuration Associate

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

📋 Description

• Manage all facets of claims benefit setup, analysis, mapping, testing, troubleshooting, and implementation.

• Ensure precise configuration of member cost-sharing, benefit restrictions, and provider payment details.

• Serve as a liaison across various departments concerning benefit and claims processing.

• Assist in the interpretation, analysis, implementation, and auditing of claims configuration, which includes benefits, authorization, denial library, CMS billing and coding guidelines, and Devoted payment policies.

• Oversee the claims benefit configuration inbox and address stakeholder inquiries while upholding turnaround times and response quality.

• Develop, execute, and uphold quality control procedures for claims configuration.

• Conduct regular reviews to improve configuration accuracy and performance.

• Lead the annual end-to-end 1/1 readiness for benefit configuration and BID application management.

• Set project timelines, maintain documentation, and ensure cross-functional alignment with MedProduct, Clinical, and Claims teams.

• Supervise the Devoted Denial Reasons library and guarantee accurate mapping of internal denial codes.

• Identify, design, and implement process enhancements to scale configuration operations, minimize error rates, and streamline cross-team execution.

⛳️ Requirements

• Demonstrated experience in analyzing data sets to derive insights and translate those insights into actionable steps.

• Strong analytical and problem-solving abilities.

• Proficiency in Google Sheets/Excel.

• Willingness and eagerness to learn new tools.

• Experience collaborating with a data analytics team on more complex data requests.

• Strong organizational skills and a background in managing high-impact workflows with tight deadlines.

• Excellent communication and collaboration abilities for working with cross-functional teams.

• Exceptional organizational skills, capable of prioritizing tasks effectively to consistently meet deadlines.

• Thrives in a fast-paced, metrics-driven environment and is comfortable with uncertainty.

• Some understanding of health insurance claims processing, regulations, and compliance requirements.

• Certified Professional Coder (CPC) certification is a plus.

• Experience working with offshore resources or distributed teams, with the capability to clearly communicate priorities and task requirements without direct managerial authority.

• Experience leveraging AI and automation to minimize manual operational tasks.

• A bachelor’s degree is preferred; relevant professional experience will be considered as a substitute for 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 except Director and above.

• Commission eligibility for Sales positions.

• Parental leave program.

• 401K program.