Claims Operations Associate II, Policy Operations

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). 

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, 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

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

• 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

Pay Transparency Statement 

This is a hybrid position based out of our Lehi office, with the expectation of being in office at least two weekdays per week. #LI-hybrid 

The actual pay rate offered within the range will depend on factors including geographic location, qualifications, experience, and internal equity. In addition to the hourly rate, you will be eligible for stock options and benefits like health insurance, 401k, and paid time off. Learn more about our benefits at https://jobs.collectivehealth.com/benefits/.