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data analytics agile vendor management operations javelina📋 Description
- Lead end-to-end processing of medical and pharmacy claims, including appeals.
- Ensure compliance with contracts, plan documents, and regulations.
- Use data to optimize claims ops and reduce inefficiencies.
- Create and maintain process flows and standard operating procedures.
- Provide business requirements and cross-functional support to tech teams.
- Support creation of innovative health benefit plans and delivery methods.
🎯 Requirements
- 15+ years in health plan ops at a TPA/carrier with self- and level-funded expertise.
- Lead, develop front-line supervisors and managers; contribute initiatives.
- Deep SME in medical claims.
- Proven project planning and execution experience.
- Working knowledge of network and provider contracts.
- Excellent communication and collaboration skills.
- Extra credit: Mphasis Javelina claims processing platform experience.
- Lean methodology knowledge.
🎁 Benefits
- Generous PTO
- Up to 16 weeks paid parental leave
- Paid holidays
- 401(k) program
- Transportation perks
- Education reimbursement
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