Claims Specialist

Waltham, MA /
Operations /
A bit about us: 

We’re on a mission to change healthcare — how it’s paid for, delivered, experienced. We want to put people center stage, not process or profit. We are guided by a deep belief that every person on Medicare should be treated like we would treat a member of our own family: with loving care and a profound commitment to their health and well-being. 

That’s why we’re gathering a whole bunch of smart, big-hearted people to create a new kind of healthcare company — one that combines compassion, health insurance, clinical care, and technology seamlessly. 

We want to throw the long ball with people we love for a cause we believe in. Life is short. Join us.

Devoted Health is a new healthcare company looking to improve the lives of seniors in America. We are guided by a deep belief that every senior should be treated like we would treat a member of our own family: with loving care and a profound commitment to their health and well-being.  With aging demographics and rising health costs, this is an industry and problem space that needs today’s best talent working on solutions with high integrity and a long term view. We will improve the lives of seniors by helping them navigate the healthcare system, by utilizing world-class technology and data to enable a simplified experience, by partnering with top providers for better health outcomes. We are building a stellar team to drive towards our starting point goal to launch a Medicare Advantage plan and clinical services in 2019.

Why Devoted:

Make a difference... a big difference. You will have the opportunity, in a unique and dynamic culture, to be a part of something incredibly meaningful. We’re a disruptive startup with an inspiring mission. Learn and grow alongside our world-class team of healthcare, technology, and data leaders, dedicated to building a health plan and clinical services that care for everyone like they were our own mothers or fathers. Our team and board members have decades of experience in health care entrepreneurship, data, technology, services, and policy. With their support, we look forward to building a health plan and clinical services that will give seniors easy access to the high-quality care they deserve.

A bit more about this role:

At Devoted, we know that one of the most important ways we will build trust is by ensuring we can pay claims accurately and on time, while providing the strategic flexibility to change payment models. Our Claims Operations team is responsible for managing claims processing and payment as well as contract and benefit configuration functions. Devoted is committed to building a team of people, effective processes and proprietary technology that delivers industry leading claims payment, accuracy and provider satisfaction. Devoted Health is building the core technology platform from the ground up. The Claims specialist  will use a variety of systems and tools to ensure claims are successfully adjudicated, accurately and on time; delivering on our promises. specialists will work collaboratively with different parts of the organization to ensure we are continuously improving our people, processes and technology. The successful candidate will be one of a few Medicare claim experts at Devoted.

Responsibilities will include:

    • Understand and apply benefits, policies and provider contract provisions to correctly adjudicate claims
    • Claims processing may be related to physician and hospital services, coordination of benefits (COB), high dollar, special contract pricing, refunds and/or adjustments
    • Collect missing information for unclean claims by working directly with provider organizations
    • Performs in depth analysis of complex claims to determine appropriate resolution
    • Functions as a subject matter expert for all varieties of claims
    • Works with other teams to resolve complex challenges and to support our members and providers
    • Shares learned experiences with the organization
    • Identify and implement creative process improvement (must be excited to roll up your sleeves and make things better!)
    • Understand and adhere to complex regulations and developing policies and procedures

Attributes to success:

    • Curiosity and willingness to ask questions
    • A deep desire to improve and make a change in the healthcare experience
    • Preference towards collaboration and preventing silos
    • You will roll up your sleeves and do whatever it takes to get the job done
    • Ability to work in a fast-paced start-up environment

Desired skills and experience:

    • 3 - 5 years experience processing claims within a Managed Care Organization 
    • Understanding of Medicare claims regulations
    • Strong analytical skills and ability to work in spreadsheets, basic sql a plus
    • Strong written and verbal communication skills
    • Experience working on; contract configuration, benefit configuration, SIU/FWA a plus
    • CPC (Certified professional coder) also a plus
If you love running towards complex challenges and transforming them into solutions, if you want to make a potentially huge impact on many lives, and if you are looking for a disruptive startup with an inspiring and talented team, Devoted Health may be the place for you! 

Devoted is an equal opportunity employer.  We are committed to a safe and supportive work environment in which all employees have the opportunity to participate and contribute to the success of the business. We value diversity and collaboration. Individuals are respected for their skills, experience, and unique perspectives. This commitment is embodied in Devoted’s Code of Conduct, our company values and the way we do business.

As an Equal Opportunity Employer, the Company does not discriminate on the basis of race, color, religion, sex, pregnancy status, marital status, national origin, disability, age, sexual orientation, veteran status, genetic information, gender identity, gender expression, or any other factor prohibited by law. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment.