Maven Clinic is the world's largest virtual clinic for women and families, providing digital programs that offer clinical, emotional, and financial support in fertility & family building, maternity & newborn care, parenting & pediatrics, and menopause & midlife.
In the role of Senior Associate, Claims and Benefits Specialist, you will own end-to-end member-level billing and reimbursement accuracy, corrections, and escalations. This senior operational position involves resolving complex billing discrepancies, conducting investigations across multiple systems, and ensuring the integrity of cost-share calculations, claims processing, eligibility inputs, and reimbursement workflows.
Responsibilities include managing complex billing and reimbursement cases from intake to resolution, investigating eligibility and claims discrepancies, reviewing reimbursement payouts for accuracy, collaborating cross-functionally with Payment Operations, Engineering, Finance, and external TPAs, and identifying process improvements to enhance billing accuracy and operational efficiency.
Effective communication with clarity and empathy is essential to explain billing determinations and resolve disputes while maintaining financial and professional standards.
- 4–5+ years experience in healthcare billing, claims operations, revenue cycle management, or benefits management.
- Deep knowledge of claims adjudication, cost-share structures, eligibility verification, and accumulator logic.
- Strong analytical skills and experience managing complex billing investigations across multiple systems.
- Familiarity with TPA platforms (e.g., Alegeus or similar billing/claims systems).
- High attention to detail and ability to document technical discrepancies accurately.
- Good judgment balancing speed, accuracy, and escalation in a fast-paced environment.
Bonus:
- Knowledge of benefits and fertility-specific insurance (cycle-based benefits, fertility medications, diagnostic coding).
- Experience driving automation and workflow improvements in claims operations.
- Experience in a high-growth startup environment.
- Access to Maven's platform and specialists in mental health, reproductive health, family planning, and pediatrics.
- Wellness partnerships supporting whole-self care.
- Hybrid work model with in-office meals and collaborative work days.
- 16 weeks 100% paid parental leave and new parent stipend (after 1 year).
- Annual professional development stipend and personal career coaching.
- 401K matching with immediate vesting (US employees).
Benefits apply to US-based full-time employees; contractors are ineligible.
Location
New York, New York, US
Employment Type
Full-time
Experience Level
Senior
Salary Range
$98,000 - $107,000
Remote work allowed
Yes
Posted
2 weeks ago