Claims Operations Associate - Policy Operations (Contract)

As part of the Claims team within Health Plan Operations, the Plan Operations team owns specialized processes that require close collaboration with finance, legal, product, and other internal teams. 

As a Contractor 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 Health Plan Operations (HPO).

What you'll do:

• 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 

To be successful in this role, you'll need:

• To be self-motivated, intellectually curious, and take ownership for everything you do
• 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 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
• 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.