General Manager
NEXT|HEALTH
Payment Operations Associate
Maven Clinic
full-time
Posted on:
Origin: • 🇺🇸 United States • New York
Visit company websiteSalary
💰 $80,000 - $85,000 per year
Job Level
JuniorMid-Level
About the role
- Review, process, and adjudicate fertility-related healthcare claims (e.g., IVF, egg retrieval, preservation, donor services, adoption services, surrogacy-related treatments) per company policies and benefit plan designs.
- Research claims issues and facilitate resolution, including requesting additional information and documentation from Members.
- Ensure tasks are completed within designated timeframes to meet internal and external SLAs.
- Adhere to federal, state, and payer-specific regulations (e.g., HIPAA, ERISA) and regulatory requirements.
- Provide clear explanations of claim determinations and reimbursement policies to stakeholders.
- Develop and iterate on standard operating procedures related to claims adjudication processes.
- Collaborate with other departments to ensure a smooth and efficient reimbursement process.
- Report to the Director of Payment Operations.
Requirements
- 3-6 years of experience in benefits management or insurance focusing on claims adjudication; fertility or women’s health experience strongly preferred.
- Specialized experience in healthcare reimbursement, particularly within fertility and/or family building.
- Understand medical billing, coding, insurance claims processing, and revenue cycle management.
- Exceptional attention to detail and accuracy.
- Strong analytical and problem-solving skills.
- Excellent communication skills; this includes written and spoken communication.
- Proficient in Microsoft Office tools.
- Ability to work independently and as part of a team.
- Strong organizational skills; demonstrated ability to multi-task and manage time effectively.
- Knowledge of federal, state, and payer-specific regulations (e.g., HIPAA, ERISA).
