Claims Benefit Configuration Senior Associate

This is a Fully Remote Job About Our Client:Founded in 2017, the organization operates in the healthcare industry focused on improving the health and well-being of older Americans. It addresses challenges in integrating data, AI, and clinical services to enhance the member experience in healthcare. About the Opportunity:The CLAIMS BENEFIT CONFIGURATION SENIOR ASSOCIATE is responsible for ensuring accurate configuration of claims benefits, including member cost shares, benefit limitations, and provider payment information. This role supports claims processing accuracy and provider satisfaction by managing configuration tasks, testing, troubleshooting, and cross-departmental communication. Responsibilities:Support interpretation, analysis, implementation, and audit of claims configuration including benefits and authorizationManage claims benefit configuration inbox and respond to stakeholder inquiriesDevelop and enforce quality control procedures for claims configurationLead annual benefit configuration readiness and BID application managementOversee denial reason library mapping and accuracyIdentify and implement process improvements to scale operations and reduce errors Requirements:Proven experience analyzing data to generate actionable insightsStrong analytical skills and proficiency with Google Sheets/ExcelExperience managing workflows with tight deadlinesExcellent communication and collaboration skillsAbility to prioritize tasks and meet deadlines in a fast-paced environmentBachelor’s degree or relevant experienceKnowledge of health insurance claims processing and regulations preferredCertified professional coder (CPC) is a plusExperience working with distributed teams and applying AI/automation to operations Pay Range and Compensation Package:Salary range: $58,000 - $96,000 annually Benefits & Perks:Employer-sponsored health, dental, and vision plans with low or no premiumGenerous paid time off$100 monthly mobile or internet stipendStock options for all employeesBonus and commission eligibility as applicableParental leave program401(k) program Equal Opportunity Statement: Our client is an equal opportunity employer. They celebrate diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, or national origin. Note:TalentHop is a recruitment partner of this role. Please note that all employment decisions, including candidate assessment, interviews, hiring, compensation, and employment terms, are made exclusively by the hiring employer.