Health Plan Operations Specialist

TrueClaim; California (MO); Hybrid; USD 60,000 - 80,000; Full time

Benefits offered by this job

Medical benefits

Vision benefits

Dental benefits

Unlimited PTO

Yearly professional development budget

Job summary

TrueClaim is looking for a dedicated Health Plan Operations team member to manage various operational workflows critical to company success. You will handle enrollment, claims management, and reconcile accounts while supporting both members and providers.

This role offers the flexibility to work remotely or in-person in San Francisco with competitive benefits and unlimited PTO. The ideal candidate thrives in fast-paced environments and is ready to contribute to building something impactful.

Qualifications

• Must be willing to adapt as job requirements may evolve.
• Experience in health plan administration is a bonus.
• Strong operational focus required.

Responsibilities

• Handle enrollment and billing processes for participants.
• Manage claims submission and payment disbursement.
• Reconcile participant accounts.
• Support members and providers via multiple channels.
• Conduct audits to resolve discrepancies.

Skills

Operational workflows

Claims management

Data auditing

Customer support

Problem-solving

Job description

About TrueClaim

TrueClaim is the “Shopify for health insurance plans” - our AI-enabled platform makes operating great health plans easier and cheaper than ever before. Thanks to our claims review AI agents, TrueClaim saves health plans at least 7% of costs vs legacy solutions. We are backed by Y Combinator and other top investors, founded by industry veterans (Hinge Health, Pine Park Health - YC, pMD) and growing fast.

About The Role

We are looking for additional team members to join our growing Health Plan Operations team as we scale and shape the future of health plan administration. This role is absolutely critical to the success of our company and will take on ownership for a wide range of operational workflows. We expect this team to work directly with the Founders on a regular basis.

What We Think You Might Do

• Handle the enrollment, eligibility, and billing processes for new and existing plan participants.
• Manage the end-to-end process of claims, including submission, review, and payment disbursement.
• Reconcile participant accounts to reflect claim payments, administrative payments, monthly contributions, and other plan activity.
• Support members and providers via email, phone, and our app.
• Conduct regular audits of data and processes to identify and resolve discrepancies, minimizing costly errors and financial risk.

What You Will Actually Do

Whatever our members and customers need at any moment. As a fast growing company, we can’t guarantee that job requirements won’t evolve. If you are looking for a stable environment, and you are not feeling excited by the prospect of rolling up your sleeves to build an innovative company from the ground up, this is not a role for you.

Please Avoid This Role If

• You want to focus on strategy not operations.
• You are looking for a predictable environment.

Bonus points

• Experience working in health plan administration.
• Demonstrated ability to “build something out of nothing”.

Logistics

This is a full time role and can be remote or in person in San Francisco. We offer competitive benefits (medical, vision, dental), unlimited PTO, and a yearly professional development budget. We are intense but believe in pacing ourselves so we can make this our - and your - life’s work.