Sana

Medical Director

• Own Sana’s clinical strategy as a payer, defining how clinical standards, coverage policies, utilization decisions, and pharmacy strategy translate into high-quality, cost-effective care
• Build and lead a small clinician-led payer team responsible for in-house complex case management, high-cost claimant review, utilization management, and medical necessity review
• Drive strategy and implementation of cost containment initiatives, including clinical partnership management, tooling, and benefit design
• Partner closely with the operations team and our PBM partner to design evidence-based cost containment programs to bend the pharmacy cost curve without degrading outcomes or adherence, and limiting member friction
• Partner with Underwriting to assess clinical risk in quoting and pricing both prospective and renewing employer groups
• Set and evolve evidence-based coverage guidelines, benefit design, and formulary policy aligned with high-value outcomes
• Work with Analytics to support medical economics, population health initiatives, and actionable insights for employer groups
• Work with Network Operations, Care Navigation, Sana’s virtual care clinic, and Case Management to prioritize future contracting based on real gaps in care for Sana members
• Serve as a primary clinical voice in the design of Sana’s internal payer tools, coverage engines, UM workflows, and cost-transparency experiences
• Evolve case management KPIs and build cost containment program reporting structures to measure efficacy and ROI

Medical Director, Health Plan

Claims Specialist

• Ensure the timely and accurate adjudication and payment of medical claims, following health plan policies and procedures, consulting with team members, care partners and advisors as necessary. Maintain accurate and up-to-date notes of all claims processed.
• Process appeals and disputes by gathering and verifying claim information, researching and resolving claim issues, and communicating outcomes to appropriate parties.
• Become an in-house expert on all claims-related matters and provide answers and support to Customer Success and Customer Support teams.
• Identify operational issues and escalate them to the appropriate internal team.
• Contribute to teamwide goals to improve claims processes and integrate additional functions into our daily operations.
• Work independently and as part of a team to meet deadlines and daily processing quotas. Your success will be measured on your ability to complete daily and weekly targets.

Medical Director, Health Plan

Claims Processor