Payment Operations Associate

Summary

Join Maven Clinic as a Payment Operations Associate and play a critical role in supporting members' fertility journeys by managing claim denials and appeals, resolving payment discrepancies, and ensuring timely payments. You will review and process complex claims, prepare appeals, communicate with insurance representatives, maintain accurate records, and identify trends in denials. This role requires 2-4 years of experience in benefits management or insurance, understanding of medical billing and coding, excellent communication skills, proficiency in relevant software, and strong organizational abilities. A bachelor's degree is a plus. Maven offers a flexible hybrid work model with a competitive salary and benefits package, including stock options, health insurance, paid parental leave, and professional development opportunities.

Requirements

• 2-4 years of experience in benefits management or insurance focusing on claims and collections
• Understand medical billing, coding, insurance claims processing, and revenue cycle management (fertility claims experience is a plus)
• Excellent communication skills; this includes written and spoken communication
• Proficient in using relevant software and tools for claims and collection management (Availity, Stedi, etc.)
• 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

Responsibilities

• Review and process complex claims related to Maven’s fertility treatments, procedures and applicable medications, and expenses related to additional paths to parenthood in accordance with company policies and benefits plan designs
• Review claims to identify instances of denials and under payments
• Prepare and submit timely, well-documented appeals and reconsiderations to insurance payers for expedited re-processing of claims
• Communicate with insurance representatives to follow up on appeals and resolve claim issues
• Maintain accurate records of appeals, claim statuses, and outcomes
• Facilitate timely and accurate payments and resolve payment disputes
• Identify patterns or trends in denials and escalate systemic issues to management
• Work with other departments to ensure a smooth and efficient payment process across all stakeholders

Preferred Qualifications

Bachelor’s degree is a plus

Benefits

• Maven for Mavens: access to the full platform and specialists, including care for mental health, reproductive health, family planning and pediatrics
• Whole-self care through wellness partnerships
• Hybrid work, in office meals, and work together days
• 16 weeks 100% paid parental leave and new parent stipend (for Mavens who've been with us for 1 year+)
• Annual professional development stipend and access to a personal career coach through Maven for Mavens
• 401K matching for US-based employees, with immediate vesting