Claims Operations Associate II- Policy Operations

At Collective Health, we’re transforming how employers and their people engage with their health benefits by seamlessly integrating cutting-edge technology, compassionate service, and world-class user experience design. 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 three 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 10,000 stock options and benefits like health insurance, 401k, and paid time off. Learn more about our benefits at https://jobs.collectivehealth.com/benefits/.Lehi, UT Pay Range$27.20—$34 USDWhy Join Us? Mission-driven culture that values innovation, collaboration, and a commitment to excellence in healthcare Impactful projects that shape the future of our organization Opportunities for professional development through internal mobility opportunities, mentorship programs, and courses tailored to your interests Flexible work arrangements and a supportive work-life balance We are an equal opportunity employer and value diversity at our company.

We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status. Collective Health is committed to providing support to candidates who require reasonable accommodation during the interview process. If you need assistance, please contact recruiting-accommodations@collectivehealth.com.

Privacy Notice For more information about why we need your data and how we use it, please see our privacy policy: https://collectivehealth.com/privacy-policy/.

Collective Health simplifies employee healthcare with an integrated technology and service solution that makes administering company health benefit plans incomparably easier and more insightful than traditional health insurance company solutions. With over a quarter of a million members and over 50 enterprise customers—including Driscoll's, Pinterest, Red Bull, RH, Zendesk, and more—Collective Health is reinventing the healthcare experience for forward-thinking organizations and their people...