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

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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.