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Senior Associate, Member Claim Processing
Devoted Health. Lead the organization's operational execution of member claim processing for the Medicare Advantage business .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in member claim processing for Medicare Advantage, with a strong focus on accuracy, compliance, and effective communication. Proven ability to analyze and document processes while collaborating with cross-functional teams to enhance operational efficiency.
Highest-signal resume keywords
Medicare Advantage Claims AdjudicationClaims Processing AccuracyProcess DocumentationData AnalyticsConversational Agility
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Claims ProcessingComplex Claims ResolutionRoot Cause AnalysisCompliance MonitoringProcess Improvement
Soft Skills
Organizational SkillsAttention to DetailClear CommunicationPersuasive WritingAutonomous Work
Tools & Technologies
SnowflakeLooker
Industry Keywords
HealthcareHealthcare TechnologyCMS Timeliness RequirementsMember ReimbursementTech Operations
About the role
Key responsibilities & impact- Lead the organization's operational execution of member claim processing for the Medicare Advantage business
- Own day-to-day member claim processing, including personally completing complex, escalated, and non-standard claims
- Monitor queue inventory, aging, and turnaround time against service level requirements
- Clear bottlenecks before they become compliance risks and escalate risks to the manager
- Adhere to SOPs and escalate complex scenarios requiring clarification
- Partner with Claims Operations, Configuration, and Tech leadership to identify root causes of processing errors and rework
- Help prevent processing defects through feedback loops
- Support processing member claim appeals and member claim cases
Requirements
What you’ll need- Super organized with an eye for detail and the ability to understand and document what matters
- Ability to process claims accurately and quickly
- Conversational agility, including the ability to reframe, refocus, and redirect conversations to achieve desired outcomes
- Ability to condense complex concepts into simple explanations with clear and concise calls to action
- Strong writing ability to craft thoughtful, clear, persuasive, accurate, plain-language, and tailored member communications
- Track record of building and maintaining process documentation that holds 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
- Ability to thrive in a fast-paced startup environment
- Capacity for high throughput while working autonomously and collaboratively
- Track record of becoming an expert with an unfamiliar tool or system
- Experience with data, analytics, and business intelligence platforms such as Snowflake or Looker preferred
Benefits
Comp & perks- 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