Member Claim Processing Senior Associate

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.

• 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 elevate any risks to your manager.
• Adhere to all SOPs and elevate 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.

• 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.

• 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.

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.