Claims Benefit Configuration Senior Associate

Job Description

A bit about this role: 

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. Devoted Health has developed a proprietary technology platform to support these objectives. 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.

Your Responsibilities and Impact will include:

• 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.

Required skills and experience: 

• 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

Desired skills and experience:

• 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

#LI-Remote

Salary range: ​$58,000 - $96,000 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.