Claims Operations Associate- Policy Operations

CollectiveHealth, Inc.•Lehi, UT

28d•$22 - $27•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 Member Services team within Customer Experience, the Plan Operations team owns specialized processes that require close collaboration with finance, legal, product, and other internal teams. As a member of the Plan Policies team, you will be responsible for the execution of workflows that are closely tied to legal including appeals, Independent Review Organizations (IRO) submissions & coordination, client plan exceptions, gap exceptions, 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
To actively seek and accept feedback, taking full accountability for decisions and their results

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, Subrogation partners, and medical network partners, etc.
Triaging & actioning member gap exception requests
Resolving Subrogation reports and complex inquiries that come from our vendor partners.
Researching member identified FWA claims
Have an understanding of inpatient pricing, or are willing to learn that process quickly to support our external facing teams..
Manage your tickets and your daily rotations
Become a SME (subject matter expert) in one or multiple categories of our body of work in our department.
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