Member Claim Processing Senior Associate

Job Description

A bit about this role:

The Sr. Associate, Member Claim Processing leads the organization's operational execution of member claim processing for our Medicare Advantage business. Reporting to the Associate Director, Claims Operations, you will serve as the dedicated owner of member claim processing—ensuring that once a claim is submitted by a member, it is processed accurately, timely, and in a way that preserves member trust.

You'll oversee a function at the intersection of operations, compliance, and member experience—responsible for compliant, accurate, and timely member claim processing.

Your Responsibilities will include:

• Own the day-to-day operational execution of member claim processing, personally completing complex, escalated, and non-standard claims that fall outside routine adjudication.
• Manage the member claim timeliness for your queue—monitor inventory, aging, and turnaround time against service level requirements. Clear bottlenecks before they become a compliance risk and escalate any risks to your manager.
• Adhere to all SOPs and escalate complex scenarios that you require clarification to process—accuracy is critical. 
• Partner with Claims Operations, Configuration, and Tech leadership to provide feedback loops on the root causes of processing errors and rework, helping to prevent defects before they occur.
• Support with processing member claim appeals and member claim cases.

Required skills and experience:

• Organization skills: super organized with an eye for detail and the ability to understand and document what matters.
• Operations minded: ability to process claims accurately and quickly.
• 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.
• Writing Skills: Strong writing ability to craft thoughtful, clear, and persuasive communications to members, ensuring messages are accurate, plain-language, and tailored to meet specific needs and contexts.
• Process documentation: track record of building and maintaining process documentation that people actually use—translating how work gets done into clear, repeatable steps that hold up under audit.
• Bachelor's degree required, or equivalent work experience.

Desired skills and experience:

• Experience in healthcare, healthcare technology, or tech operations, preferred
• Experience with Medicare Advantage claims adjudication, member reimbursement, or CMS timeliness requirements, preferred
• Proven ability to thrive in a fast-paced startup environment
• 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

#LI-Remote

Salary range: $58,000 - $82,000 annually

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.

Founded in 2017, Devoted Health is on a mission to dramatically improve the health and well-being of older Americans by caring for everyone like they are family, and that includes our employees. Our robust and seamlessly integrated care platform merges advanced data and AI access with world-class clinical and service experiences to create a member experience that is unlike the industry norm. To continue building upon our mission, we want to bring together those who share our values, embrace change and advancement, and are enthusiastic about where we're going — all the while bringing their own unique qualities, experiences, and expertise, in hopes of further changing the healthcare experience.

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.