Member Claim Processing Senior Associate

devoted; United States; Remote; USD 58,000 - 82,000; Full time

Benefits offered by this job

Health, dental and vision coverage

Generous paid time off

Mobile/internet stipend

Stock options

Bonus eligibility for most roles

Parental leave

401K plan

Job summary

Devoted Health seeks a Sr. Associate, Member Claim Processing to own day-to-day processing of member claims for our Medicare Advantage program, ensuring accuracy, timeliness, and trust with members.

You will report to the Associate Director, Claims Operations and operate at the intersection of operations, compliance, and member experience. Responsibilities include handling complex claims, managing timeliness metrics, adhering to SOPs, partnering with Claims Ops, Configuration, and Tech, and

Qualifications

• Bachelor's degree or equivalent work experience.
• Strong organization skills and attention to detail.
• Ability to process claims accurately and quickly.
• Excellent written and verbal communication; ability to simplify complex concepts.

Responsibilities

• Own day-to-day execution of member claim processing, handling complex and escalated claims.
• Manage timeliness, queue inventory, aging, and turnaround against service levels.
• Follow SOPs and escalate unclear cases to ensure processing accuracy.
• Collaborate with Claims Operations, Configuration, and Tech to reduce defects.
• Support processing member claim appeals and related cases.

Skills

Organization skills

Operations mindset

Communication skills

Writing skills

Process documentation

Education

Bachelor's degree or equivalent

Tools

Snowflake

Looker

Job description

Job Description

A bit about this role:

The Sr. Associate, Member Claim Processing leads the organization's operational execution of member claim processing for our Medicare Advantage business. Reporting to the Associate Director, Claims Operations, you will serve as the dedicated owner of member claim processing-ensuring that once a claim is submitted by a member, it is processed accurately, timely, and in a way that preserves member trust.

You'll oversee a function at the intersection of operations, compliance, and member experience-responsible for compliant, accurate, and timely member claim processing.

Your Responsibilities will include:

• Own the day-to-day operational execution of member claim processing, personally completing complex, escalated, and non-standard claims that fall outside routine adjudication.
• Manage the member claim timeliness for your queue-monitor inventory, aging, and turnaround time against service level requirements. Clear bottlenecks before they become a compliance risk and escalat any risks to your manager.
• Adhere to all SOPs and
  escalate complex scenarios that you require clarification to process-accuracy is critical.
• Partner with Claims Operations, Configuration, and Tech leadership to provide feedback loops on the root causes of processing errors and rework, helping to prevent defects before they occur.
• Support with processing member claim appeals and member claim cases.

Required skills and experience:

• Organization skills: super organized with an eye for detail and the ability to understand and document what matters.
• Operations minded: ability to process claims accurately and quickly.
• Communication skills: conversational agility expertise demonstrated by the ability to reframe, refocus, and redirect conversations to realize accretive partnerships and desired outcomes. Additionally, this individual needs to be able to condense complex concepts into simple explanations with clear and concise calls to action.
• Writing Skills: Strong writing ability to craft thoughtful, clear, and persuasive communications to members, ensuring messages are accurate, plain-language, and tailored to meet specific needs and contexts.
• Process documentation: track record of building and maintaining process documentation that people actually use-translating how work gets done into clear, repeatable steps that hold up under audit.
• Bachelor's degree required, or equivalent work experience.

Desired skills and experience:

• Experience in healthcare, healthcare technology, or tech operations, preferred
• Experience with Medicare Advantage claims adjudication, member reimbursement, or CMS timeliness requirements, preferred
• Proven ability to thrive in a fast-paced startup environment
• Capacity for high throughput, while working both autonomously and collaboratively with others
• Track record of success becoming an expert with a tool or system that was unfamiliar to you
• Experience with Data, Analytics, & Business Intelligence Platforms, such as Snowflake or Looker, preferred

Salary range: $58,000 - $82,000 annually

#LI-Remote

Our Total Rewards package includes:

• 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
• And more....

*Our total rewards package is for full time employees only. Intern and Contract positions are not eligible.

Founded in 2017, Devoted Health is on a mission to dramatically improve the health and well-being of older Americans by caring for everyone like they are family, and that includes our employees. Our robust and seamlessly integrated care platform merges advanced data and AI access with world-class clinical and service experiences to create a member experience that is unlike the industry norm. To continue building upon our mission, we want to bring together those who share our values, embrace change and advancement, and are enthusiastic about where we're going - all the while bringing their own unique qualities, experiences, and expertise, in hopes of further changing the healthcare experience.

Devoted is an equal o