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.

Responsibilities and Impact

• 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.

Requirements 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

Pay Range

The pay range listed for this position is $58,000 - $96,000 annually. 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.

Total Rewards Package

• Employer-sponsored health, dental, and vision plans with low or no premiums
• 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

About Devoted Health

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.