At Collective Health, we’re transforming how employers and their people engage with their health benefits by seamlessly integrating cutting-edge technology, compassionate service, and world-class user experience design.
As part of the Claims team within Health Plan Operations, the Plan Operations team owns specialized processes that require close collaboration with finance, legal, product, and other internal teams.
As a Contractor of the Claims Operations team, you will be responsible for the execution of workflows that are closely tied to legal including client plan exceptions, gap exceptions, subrogation, out-of-network pricing and more. You will be responsible for the development of policies & procedures that enable successful operations and ensure operational compliance on the Member Claims team as well as other teams within Health Plan Operations (HPO).
What you'll do:- Support the execution of the day-to-day operations of our medical plans, including but not limited to:
- Coordinating with third parties such as, Subrogation partners, and medical network partners, etc.
- Triaging & actioning member gap exception requests
- Resolving Subrogation reports and complex inquiries that come from our vendor partners.
- Researching member identified FWA claims
- Have an understanding of inpatient pricing, or are willing to learn that process quickly to support our external facing teams..
- Manage your tickets and your daily rotations
- Become a SME (subject matter expert) in one or multiple categories of our body of work in our department.
- Work cross-functionally on issues with Legal, Member Advocacy, Collective Care, and the Member Claims teams to delight our members
- Support quarterly team projects focused on process scalability, workflow and other operational improvements
- Attend weekly office hours & team working sessions to collaborate on, discuss, and help resolve various issues that are escalated to our team as they arise
- To be self-motivated, intellectually curious, and take ownership for everything you do
- Extreme attention to detail
- To use good judgment and are comfortable when handling sensitive matters
- To think critically and are willing to question the status quo in a constructive and thoughtful manner
- To enjoy researching, discussing, and developing consistent policies and approaches to work, and are comfortable operating in ambiguous situations where there is no clear right answer
- To thrive on change and are enthusiastic about being along for the ride and learning from our experiences together
- Excellent verbal, written and interpersonal communication skills
- A passion for Collective Health’s mission to transform the health insurance experience for employers and their employees
- To actively seek and accept feedback, taking full accountability for decisions and their results.
- Mission-driven culture that values innovation, collaboration, and a commitment to excellence in healthcare
- Impactful projects that shape the future of our organization
- Opportunities for professional development through internal mobility opportunities, mentorship programs, and courses tailored to your interests
- Flexible work arrangements and a supportive work-life balance
We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status. Collective Health is committed to providing support to candidates who require reasonable accommodation during the interview process. If you need assistance, please contact [email protected].
Privacy NoticeFor more information about why we need your data and how we use it, please see our privacy policy: https://collectivehealth.com/privacy-policy/.
Skills Required
- Extreme attention to detail
- Excellent verbal and written communication skills
- Ability to handle sensitive matters
- Intellectual curiosity and self-motivation
- Experience with claims processes is a plus
Collective Health Compensation & Benefits Highlights
The following summarizes recurring compensation and benefits themes identified from responses generated by popular LLMs to common candidate questions about Collective Health and has not been reviewed or approved by Collective Health.
-
Healthcare Strength — Benefits include competitive medical, dental, and vision coverage with options for $0 employee-only premiums and no waiting period, with some plans offering very low out-of-pocket costs. Feedback suggests this level of coverage is a standout element of the total package.
-
Leave & Time Off Breadth — Generous time-off programs encompass ample PTO, 12 paid holidays, baby-bonding leave with a supportive return-to-work program, and a fully paid four-week sabbatical after five years. Feedback suggests these elements meaningfully enhance overall rewards beyond cash.
-
Wellbeing & Lifestyle Benefits — A $100 monthly wellness stipend, access to Headspace resources, commuter support, and optional add-on insurances provide breadth and flexibility in day-to-day benefits. Feedback suggests these lifestyle supports contribute tangible value alongside salary.
Collective Health Insights
What We Do
Collective Health is a technology company simplifying employer healthcare to make health insurance work for everyone. With more than a quarter million members and over 60 enterprise clients—including Pinterest, Restoration Hardware, and more—our technical and customer experience teams are reinventing the healthcare experience for employers and their people.
Why Work With Us
Collective Health has a mighty mission—to make the American healthcare system effortless—and a culture focused empathy, authenticity, curiosity, and a need to solve hard problems. We have a diverse, mission-driven team with doctors working alongside data scientists and nuclear engineers to reinvent the the healthcare experience for everyday people.
Gallery
.png)
