Health Plan Quality Control Associate

At Collective Health, we’re transforming how employers and their people engage with their health benefits by seamlessly integrating cutting-edge technology, compassionate service, and world-class user experience design.

As part of the Member Services team within Customer Experience, the Plan Operations team owns specialized processes that require close collaboration with finance, legal, product, and other internal teams. The Plan Operations -- Plan Structure, Launch & Design team (PSL&D) will be responsible for owning and further developing key processes that support and enable the Member Claims team and successful client implementations. PSL&D owns, builds, and maintains Collective Health’s core business logic and system while implementing our clients’ healthcare plans onto the Collective Health platform.

What You'll Do

• Provide subject matter expertise for all quality control activities and provide required training to maintain quality policies and procedures related to the Plans Platform ecosystem.
• Perform regular quality control activities and necessary updates on Plans Platform to ensure all benefit categories, CPT codes, etc. are current.
• Collaborate with Health Plan Benefits Associates to ensure accurate artifact generation (SBCs, SPDs, OE takeaways, network benefit grids, portals)
• Maintain robust quality assurance protocols throughout the implementation process for new and renewal clients.
• Support new and existing team members by holding training meetings and attending office hours to ensure quality standards are understood and upheld
• Own complex and/or high priority benefit builds and modifications for new and existing benefits
• Assist in managing and supporting the end-to-end implementation process for new and renewal clients.
• Apply a scalability lens to several key areas in Plan Operations -- plan stack, plan testing, data gathering workflows, plan design and analytics inquiries, and more including:
• Working with software engineers to build internal tools to improve processes
• Collaborate cross-functionally with Member Claims, Product, Development, Legal, Clinical, Copy, and Client Success teams to delight our customers
  
  

To Be Successful In This Role, You

• Have healthcare industry experience and coding knowledge base
• Are self-motivated, intellectually curious, and take ownership for everything you do
• Have Excellent Microsoft Office and/or Google Suites skills, particularly in Excel / gSheets and PowerPoint / Slides
• Have strong analytical thinking and problem-solving skills to collect, organize, analyze, and disseminate information with extreme attention to detail and accuracy
• Are CPC or CCS certified or have worked in the healthcare industry for at least 1 year
• Think critically and are willing to question the status quo in a constructive and thoughtful manner
• Enjoy adding structure & taking a methodical approach to problems
• Are a committed team player
• Thrive on change and are enthusiastic about being along for the ride and learning from our experiences together
• Possess a passion for Collective Health’s mission to transform the health insurance experience for employers and their employees
• Are hyper attentive to details and processes
  
  

Pay Transparency Statement

This is a hybrid position based out of our Lehi office, with the expectation of being in office at least two weekdays per week.

The actual pay rate offered within the range will depend on factors including geographic location, qualifications, experience, and internal equity. In addition to the hourly rate, you will be eligible for stock options and benefits like health insurance, 401k, and paid time off. Learn more about our benefits at https://jobs.collectivehealth.com/benefits/.

Lehi, UT Pay Range

$21.55—$26.95 USD

Why Join Us?

• Mission-driven culture that values innovation, collaboration, and a commitment to excellence in healthcare
• Impactful projects that shape the future of our organization
• Opportunities for professional development through internal mobility opportunities, mentorship programs, and courses tailored to your interests
• Flexible work arrangements and a supportive work-life balance
  
  

We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status. Collective Health is committed to providing support to candidates who require reasonable accommodation during the interview process. If you need assistance, please contact recruiting-accommodations@collectivehealth.com.

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