Health Plan Operations Associate

Summary

Join Firefly Health, a revolutionary healthcare company, as a Health Plan Associate! You will play a crucial role in resolving member and provider claims inquiries, ensuring smooth operations and outstanding customer experiences. This position demands strong attention to detail, problem-solving skills, and a commitment to continuous improvement. You will investigate and resolve claims, identify process improvements, and collaborate with cross-functional teams. The role offers a largely remote work structure with occasional on-site gatherings. Firefly Health values diversity and inclusion, creating a supportive and respectful workplace.

Requirements

• Minimum of 2 years of experience working with health plans or in a similar role involving claims management
• Exceptional attention to detail, ensuring accuracy in capturing and resolving claims inquiries
• Strong problem-solving skills and a bias towards taking initiative and action
• Curiosity to understand the root causes of issues and a passion for continuous improvement
• Excellent communication skills, both written and verbal, with the ability to convey complex information clearly
• Proficiency with claims systems and a strong aptitude for learning new tools and technologies
• Ownership mentality, with the ability to see tasks through to completion independently
• A customer-first approach, with a dedication to providing a superior experience for members and providers
• Adaptability and willingness to thrive in a fast-paced, dynamic environment

Responsibilities

• Capture, document, and triage member and provider claims inquiries
• Investigate and resolve claims issues within SLA, ensuring accurate and timely communication to stakeholders
• Serve as a point of contact for escalations, ensuring satisfactory resolution and a positive customer experience
• Maintain a high standard of professionalism and empathy in all interactions with members and providers
• Proactively follow up on outstanding issues to ensure resolution and satisfaction
• Analyze trends in inbound inquiries to identify root causes and recommend process improvements
• Partner with cross-functional teams to implement solutions that reduce inquiry volume and improve workflows
• Provide feedback to enhance tools and systems used for claims management
• Work closely with internal teams to escalate and resolve complex issues
• Prepare regular reports on inquiry resolution metrics and performance against SLAs

Preferred Qualifications

• Familiarity with common health plan operations & terms, including claims adjudication, member services, or provider relations
• Experience working with process improvement initiatives, such as Lean or Six Sigma methodologies
• You are very comfortable working with Google Work products including GMail, Google Sheets, Google Slides, Looker, and Google Drive
• SQL and data analysis experience preferred

Benefits

This role can be done largely remotely, there are several times a year when staff come together onsite for planning and team building