Claim Operations Associate II

Collective Health•Plano, TX

6h•Hybrid

About The Position

At Collective Health, we’re transforming how employers and their people engage with their health benefits by seamlessly integrating cutting-edge technology, compassionate service, and world-class user experience design. As part of the Claims team within Health Plan Operations, the Plan Operations team will own processes that require close collaboration with finance, legal, product, and other internal teams. The Plan Operations - Systems team ensures our production systems are working accurately and partners with our Product team to resolve issues that arise. As a member of the team, you’ll work on claims systems issues, Ingenuity testing and development, and accumulator reconciliations.

Requirements

At least 2-5 years of claims payment or claim operations experience.
Familiarity with X12 837 and 835 standards
To have working knowledge of claims workflows and associated processes
To pay extreme attention to detail
To enjoy connecting the dots & communicating complexities
To be excited about reimagining how we structure our body of work to align with the new service design
To be a strong performers within your current role
To be a committed team player
To thrive on change and are enthusiastic about being along for the ride and learning from our experiences together
A passion for Collective Health’s mission to transform the health insurance experience for employers and their employees

Responsibilities

Support the execution of the day-to-day operations of our medical plans, including but not limited to:
Resolving errors related to medical 835 forms and claim finalization
Triaging & troubleshooting claim processing related bugs and issues
Loading 837s and one off claims into our claims network via the manual load process
Own & apply a scalability lens to several key areas surrounding our manual 835 error resolution process
Assist in research and improvement of our 835 integrations
Identify and lead quality/process improvement projects within Claim Operations and across CX.
Build (and/or work with the development team to build) internal tools to improve processes as we identify and fix problems relating to claims adjudication
Collaborate cross-functionally with Member Claims, Legal, Product, Development, and Product Operations teams to delight our customers