Claims Representative

| Waltham
A bit about us:
We’re on a mission to change healthcare — how it’s paid for, delivered, experienced. We want to put people center stage, not process or profit. We are guided by a deep belief that every person on Medicare should be treated like we would treat a member of our own family: with loving care and a profound commitment to their health and well-being.
That’s why we’re gathering a whole bunch of smart, big-hearted people to create a new kind of healthcare company — one that combines compassion, health insurance, clinical care, and technology seamlessly.
We want to throw the long ball with people we love for a cause we believe in. Life is short. Join us.
At Devoted, we know that one of the most important ways we will build trust is by ensuring we can pay claims accurately and on time, while providing the strategic flexibility to change payment models. Our Claims Operations team is responsible for managing claims processing and payment as well as contract and benefit configuration functions. Devoted is committed to building a team of people, effective processes and proprietary technology that delivers industry leading claims payment, accuracy and provider satisfaction. Devoted Health is building the core technology platform from the ground up. The Claims Representative will use a variety of systems and tools to ensure claims are successfully adjudicated, accurately and on time; delivering on our promises. Representatives will work collaboratively with different parts of the organization to ensure we are continuously improving our people, processes and technology. The successful candidate will be one of a few Medicare claim experts at Devoted.

Responsibilities will include:

  • Understand and apply benefits, policies and provider contract provisions to correctly adjudicate claims
  • Claims processing may be related to physician and hospital services, coordination of benefits (COB), high dollar, special contract pricing, refunds and/or adjustments
  • Collect missing information for unclean claims by working directly with provider organizations
  • Performs in depth analysis of complex claims to determine appropriate resolution
  • Functions as a subject matter expert for all varieties of claims
  • Works with other teams to resolve complex challenges and to support our members and providers
  • Shares learned experiences with the organization
  • Identify and implement creative process improvement (must be excited to roll up your sleeves and make things better!)Understand and adhere to complex regulations and developing policies and procedures

Attributes to success:

  • Curiosity and willingness to ask questions
  • A deep desire to improve and make a change in the healthcare experience
  • Preference towards collaboration and preventing silos
  • You will roll up your sleeves and do whatever it takes to get the job done

Desired skills and experience:

  • 3 - 5 years experience processing claims within a Managed Care Organization Understanding of Medicare claims regulations
  • Strong analytical skills and ability to work in spreadsheets, basic sql a plus
  • Strong written and verbal communication skills
  • Experience working on; contract configuration, benefit configuration, SIU/FWA a plus
  • CPC (Certified Professional Coder) also a plus

If you love running towards complex challenges and transforming them into solutions, if you want to make a potentially huge impact on many lives, and if you are looking for a disruptive startup with an inspiring and talented team, Devoted Health may be the place for you!

Read Full Job Description

Technology we use

  • Engineering
    • GolangLanguages
    • PythonLanguages
    • TypeScriptLanguages
    • ReactLibraries
    • recomposeLibraries
    • Apollo GraphQLLibraries
    • AngularJSFrameworks
    • gRPCFrameworks
    • AWSFrameworks
    • PostgreSQLDatabases
    • RedshiftDatabases

Location

Our sunny office is in the beautiful Watch Factory alongside the Charles River in Waltham. It's easily reachable by commuter train, bus, or bike.
221 Crescent Street, Waltham, MA 02453

What are Devoted Health Perks + Benefits

Devoted Health Benefits Overview

We offer bright, open office space with plenty of flexibility, awesome colleagues and a strong focus on our mission and supporting the work/life balance of all Devotees. We believe that taking care of ourselves will help us deliver the best possible service to our members.

We offer a free(100% employer paid) HMO Plan through Blue Cross Blue shield for our employees and their families. We also offer a PPO plan at a very limited cost.

Health Insurance & Wellness Benefits
Flexible Spending Account (FSA)
Dental Benefits
Fully company paid through Blue Cross Blue Shield
Vision Benefits
Fully company paid through Blue Cross Blue Shield
Health Insurance Benefits
We offer a free(100% employer paid) HMO Plan through Blue Cross Blue shield for our employees and their families. We also offer a PPO plan at a very limited cost.
Life Insurance
Offered through the Hartford
Wellness Programs
Wellness program where you can earn money back for healthy behavior along with an onsite gym and cross fit classes onsite
Onsite Gym
Yes, in our facility
Retirement & Stock Options Benefits
401(K)
Yes, we offer a 401K
Company Equity
Equity offered to all Devotees
Child Care & Parental Leave Benefits
Generous Parental Leave
We offer 3 months fully paid for maternity leave and 1 month paternity leave
Flexible Work Schedule
Family Medical Leave
Yes
Vacation & Time Off Benefits
Unlimited Vacation Policy
Generous PTO Polity
Generous PTO
Perks & Discounts
Casual Dress
We embrace the "bring your whole self to work" mantra and want folks to feel comfortable doing their best work
Company Outings
Company retreats, happy hours and team events
Stocked Kitchen
We offer healthy snacks including fresh fruit, bagels and cream cheese, popcorn, energy bars and dark chocolate.
Some Meals Provided
Free lunch weekly
Parking
Free parking onsite
Fitness Subsidies
BCBS reimburses up to 3 months of health club fees
Professional Development Benefits
Job Training & Conferences
We encourage and support our employees in continuing their educational endeavors.
Diversity Program
Devoted has a strong focus on building the most diverse and inclusive workforce we can. We won a 2018 NEVY award for diversity

Additional Perks + Benefits

The people at Devoted are drawn together with the common mission of making a material difference in the healthcare system as a whole and specifically in the lives of the members we serve. We are the type of company that supports employees as they move through the stages of their life while providing constant learning and opportunities for growth and change.

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