Remote Health Policy Lead for Benefits & Claims

Intermountain Healthcare Inc.; Augusta (ME); Remote; USD 43,000 - 67,000; Full time

Job summary

Intermountain Health's SelectHealth - Murray is seeking a seasoned policy leader to drive health plan policy development and adjudication rule implementation. You will bridge policy concepts with operational practice, guiding teams across departments to ensure compliant benefit design and provider reimbursement workflows.

The role emphasizes analytical research, cross-functional collaboration, and ongoing policy oversight, including coding determinations and updates to coverage rules.

Qualifications

• Four years of policy experience.
• Two years in a medical benefits or insurance setting, or related experience to gain understanding of claims and eligibility.
• Experience managing projects with strong interpersonal and organizational skills and ability to meet deadlines.
• Excellent oral, written, and interpersonal communication skills.
• Intermediate skills in computer-based word processing and spreadsheets.

Responsibilities

• Leads policy research from initial request to analysis and implementation.
• Develops policies aligned with goals and strategy, and assesses impact.
• Presents recommendations and implementation considerations to senior management.
• Oversees implementation of approved policy changes with cross-functional teams.
• Provides input and resources for projects needing policy expertise.
• Stays current on changes and informs benefit quoting and adjudication processes.
• Oversees coding review and coverage determinations; implement changes as needed.
• Champions initiatives for policy changes.
• Participates in committees to ensure consistent policy development.
• Assists in other product development activities and projects.

Skills

Health Care Regulation

Communication

Project Management

Decision Making

Attention to Detail

Analytical Thinking

People Management

Cultivates Necessary Relationships

Initiative

Accountability

Education

Bachelor's degree in business or healthcare

Project management experience (4+ years)

Tools

Claims adjudication systems

Job description

Intermountain Health's SelectHealth - Murray is seeking a seasoned policy leader to drive health plan policy development and adjudication rule implementation. You will bridge policy concepts with operational practice, guiding teams across departments to ensure compliant benefit design and provider reimbursement workflows.

The role emphasizes analytical research, cross-functional collaboration, and ongoing policy oversight, including coding determinations and updates to coverage rules.