Claims Operations Senior Associate

Job Description

A bit about this role:

The Senior Associate, Claims Operations leads the organization’s operational execution of provider refund check processing for our Medicare Advantage business. Reporting to the Senior Manager of Provider Disputes, Appeals & Recoupments, you will serve as the dedicated owner of the refund check lifecycle—ensuring that once a refund check is received from a provider, it is processed accurately, timely, and in a way that preserves provider relationships.

You’ll oversee a function at the intersection of operations, finance, and compliance—responsible for the governance and execution of provider refund check processing. You’ll collaborate closely with Claims Operations, Tech, Payment Integrity, Network, and Finance to ensure fair, consistent, and compliant outcomes.

Your Responsibilities will include:

• Oversee day-to-day operational execution of provider refund check processing.

• Partner with Payment Integrity and Claims leadership to provide feedback loops on the root causes of overpayments, helping to prevent leakage before it occurs.

• Partner with Finance and Accounting to ensure accurate reconciliation of recouped funds, proper allocation to the general ledger, and precise financial reporting that is auditable.

• Use data analytics to identify trends and opportunities to improve our processes.

• Support the Appeals and Disputes function of our team

Required skills and experience:

• Strategic analytical horsepower: Proven ability to leverage complex data sets to inform strategic initiatives and team development, while articulating compelling, data-driven narratives that drive organizational vision and ensure alignment.

• Operations minded: define an endpoint and formulate & execute against a plan for getting there, with quantifiable mile markers along the way.

• Relationship builder: expert at building relationships

• Communication skills: conversational agility expertise demonstrated by the ability to reframe, refocus, and redirect conversations to realize accretive partnerships and desired outcomes.  Additionally, this individual needs to be able to condense complex concepts into simple explanations with clear and concise calls to action.

• Organization skills: super organized with an eye for detail and the ability to understand and document what matters. Staying organized is a critical component of being able to pivot between going deep into the details and stepping back to see themes or levers that inform strategy.

• Writing Skills: Strong writing ability to craft thoughtful, clear, and persuasive communications to providers, ensuring messages are data-driven and tailored to meet specific needs and contexts.

• Bachelor’s degree required, or equivalent work experience

Desired skills and experience:

• Experience in healthcare technology, consulting, or tech operations, preferred

• Proven ability to thrive in a fast-paced startup environment

• You build strong cross-functional relationships, prioritizing collaborative and empathetic communication

• Capacity for high throughput, while working both autonomously and collaboratively with others

• Track record of success becoming an expert with a tool or system that was unfamiliar to you

• Experience with Data, Analytics, & Business Intelligence Platforms, such as Snowflake or Looker, preferred

• Experience using Large Language Models to optimize business processes, preferred

#LI-Remote
 

Salary range: $55,000 - $90,000 / year

The pay range listed for this position is the range the organization reasonably and in good faith expects to pay for this position at the time of the posting. Once the interview process begins, your talent partner will provide additional information on the compensation for the role, along with additional information on our total rewards package. The actual base salary offered will depend on a variety of factors, including the qualifications of the individual applicant for the position, years of relevant experience, specific and unique skills, level of education attained, certifications or other professional licenses held, and the location in which the applicant lives and/or from which they will be performing the job.

Our Total Rewards package includes:

• Employer sponsored health, dental and vision plan with low or no premium

• Generous paid time off

• $100 monthly mobile or internet stipend

• Stock options for all employees

• Bonus eligibility for all roles excluding Director and above; Commission eligibility for Sales roles

• Parental leave program

• 401K program

• And more....

*Our total rewards package is for full time employees only. Intern and Contract positions are not eligible.

Healthcare equality is at the center of Devoted’s mission to treat our members like family.  We are committed to a diverse and vibrant workforce. 

At Devoted Health, we’re on a mission to dramatically improve the health and well-being of older Americans by caring for every person like family. That’s why we’re gathering smart, diverse, and big-hearted people to create a new kind of all-in-one healthcare company — one that combines compassion, health insurance, clinical care, service, and technology - to deliver a complete and integrated healthcare solution that delivers high quality care that everyone would want for someone they love. Founded in 2017, we've grown fast and now serve members across the United States.  And we've just started. So join us on this mission!

Devoted is an equal opportunity employer. We are committed to a safe and supportive work environment in which all employees have the opportunity to participate and contribute to the success of the business. We value diversity and collaboration. Individuals are respected for their skills, experience, and unique perspectives. This commitment is embodied in Devoted’s Code of Conduct, our company values and the way we do business.

As an Equal Opportunity Employer, the Company does not discriminate on the basis of race, color, religion, sex, pregnancy status, marital status, national origin, disability, age, sexual orientation, veteran status, genetic information, gender identity, gender expression, or any other factor prohibited by law. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment.