Claims Operations Associate II- Policy Operations

Collective Health•Lehi, UT

3h•$27 - $34•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. We all depend on healthcare throughout our lifetimes, for ourselves, and our families and friends, but it is notoriously difficult to navigate and understand. As an industry that comprises 20% of the US economy we think healthcare should work better for all of us. At Collective Health we believe it’s time for a new day in healthcare where as members we are informed and empowered to make the right care choices when the decisions are urgent and critical. As part of the Claims Operations department within Customer Experience, the Policy Operations team owns execution of workflows that are closely tied to legal including, client plan exceptions, gap exceptions, subrogation, out-of-network pricing and more. As a member of the Claims Operations team, you will be responsible for the execution of workflows that are closely tied to legal including client plan exceptions, gap exceptions, subrogation, out-of-network pricing and more. You will be responsible for the development of policies & procedures that enable successful operations and ensure operational compliance on the Member Claims team as well as other teams within Customer Experience (CX).

Requirements

To be self-motivated, intellectually curious, and take ownership for everything you do
To pay extreme attention to detail
To use good judgment and are comfortable when handling sensitive matters
To think critically and are willing to question the status quo in a constructive and thoughtful manner
To enjoy researching, discussing, and developing consistent policies and approaches to work, and are comfortable operating in ambiguous situations where there is no clear right answer
To have been, at a minimum, meeting all expectations in your current role at Collective Health
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
Excellent verbal, written and interpersonal communication skills
To possess 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:
Coordinating with third parties such as, out-of-network (OON) negotiation partners, and medical network partners
Triaging & actioning member gap exception requests
Resolving out-of-network pricing inquiries and working in collaboration with our OON pricing partner
Working with our subrogation vendors and Client Success to resolve open cases
Researching member identified FWA claims
Work cross-functionally on issues with Legal, Member Advocacy, Collective Care, and the Member Claims teams to delight our members
Support quarterly team projects focused on process scalability, workflow and other operational improvements
Attend weekly office hours & team working sessions to collaborate on, discuss, and help resolve various issues that are escalated to our team as they arise