[Hiring] Claims Benefit Configuration Senior Associate @Devoted Health

Role Description

At Devoted, we understand that building trust hinges on our ability to pay claims accurately and on time, while maintaining the flexibility to adapt payment models as needed. Our Claims Configuration Operations team manages claims system logic, benefit and authorization configuration as well as claims processing communication functions to ensure industry-leading claims payment accuracy and provider satisfaction. The Claims Benefit Configuration Senior Associate is responsible for overseeing all aspects of claims benefit setup, analysis, mapping, testing, troubleshooting, and implementation. This role ensures the successful and accurate configuration of member cost share, benefit limitations, and provider payment information. The ideal candidate will act as a liaison across all departments regarding benefit and claims processing, ensuring seamless operations and effective communication.

• Support all aspects (interpretation, analysis, implementation and audit) of claims configuration including but not limited to benefits, authorization, devoted denial library, and maintaining alignment with CMS billing and coding guidelines and Devoted payment policies.
• Manage the claims benefit configuration inbox and support responses to questions from key stakeholders maintaining turnaround times and quality of responses.
• Develop, implement, and enforce quality control procedures related to claims configuration, performing routine reviews to enhance configuration accuracy and performance.
• Lead end-to-end 1/1 annual readiness for benefit configuration, and BID application management establishing project timelines, maintaining documentation, and facilitating cross-functional alignment across teams like MedProduct, Clinical, and Claims.
• Oversee the Devoted Denial Reasons library, working with key stakeholders to ensure accurate, valid mapping of all current internal denial codes.
• Identify opportunities, design and implement creative process improvements to scale configuration operations, reduce error rates, and streamline cross-team execution.

Qualifications

• Proven experience analyzing data sets to generate insights and turn those insights into action.
• Strong analytical and problem-solving skills, with fluency in Google Sheets/Excel, ability and desire to learn new tools, and experience working with data analytics team on more involved data asks.
• Strong organizational skills and experience managing high-impact workflows with compressed timelines.
• Excellent communication and collaboration skills for working with cross-functional teams.
• Exceptional organizational skills, adept at prioritizing tasks effectively to consistently meet deadlines.
• Thrives in a fast-paced, metrics-driven environment and is comfortable with ambiguity.

Requirements

• Bachelor’s degree. Relevant professional experience will be considered in lieu of a bachelor's degree.
• Some knowledge of health insurance claims processing, regulations, and compliance requirements.
• Certified professional coder (CPC) is a plus.
• Experience collaborating with offshore resources or distributed teams, with the ability to clearly communicate priorities and task requirements without direct managerial authority.
• Experience applying AI and automation to reduce manual operational work.

Benefits

• 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....