Build Maven’s ability to drive sales through payer channels through strategic and analytic support to identify potential clients for all Maven programs and build a business case for them.
Lead end‑to‑end outcome evaluations for payer clients, designing robust methodologies and performing hands‑on analyses of medical and pharmacy claims, eligibility files and Maven platform data.
Own technical and clinical relationships with payer stakeholders, serving as their primary point of contact for study design, data sharing, results interpretation and ongoing analytic support.
Maven is the world's largest virtual clinic for women and families on a mission to make healthcare work for all. More than 2,000 employers and health plans trust Maven's end-to-end platform to improve clinical outcomes, reduce healthcare costs, and provide equity in benefits programs.
Work with Transportation Providers and resolve service issues.
Coordinate and conduct monthly provider performance evaluations.
Manage day-to-day vendor interactions and ensure satisfaction.
Jobgether uses an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Their system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company.
Developing advanced analyses of health plan and employer data.
Translating data into actionable strategies that support value-based care.
Building repeatable, intuitive reports and dashboards.
Guidehealth is a data-powered, performance-driven healthcare company dedicated to operational excellence. They aim to make healthcare affordable, improve patient health, and restore fulfillment in practicing medicine for providers. Driven by empathy and AI, Guidehealth leverages Healthguides™ and a Managed Service Organization to build stronger connections with patients and providers.
Lead our Eligibility team to ensure our participants maintain eligibility for PACE services.
Proactively identify and mitigate risks pertaining to participant eligibility.
Oversee participant demographic, eligibility and enrollment data integrity across Welbe systems.
WelbeHealth's interdisciplinary team provides all-inclusive care to vulnerable seniors. The company is rapidly expanding and has an encouraging and loving environment where every person feels uniquely cared for.
Gather, validate, and prepare data from multiple sources.
Identify missing or inconsistent fields and partner with Operations to resolve issues.
Zócalo Health is the first tech-driven provider built specifically for Latinos, by Latinos, developing a new approach to care designed around shared and lived experiences. Founded in 2021, they are backed by leading healthcare and social impact investors.
Lead payor contract implementations, requiring both internal and external cross-functional stakeholder management
Drive revenue cycle issue resolutions (claims processing, credentialing), which includes coordination with payors and internal operations teams
Spearhead cross-functional strategic initiatives that have an impact on revenue (implementation of new product/service lines, as an example)
Ophelia is a venture-backed healthcare startup that provides medication and clinical care through a telehealth platform to help individuals with OUD (opioid use disorder). They are a team of physicians, scientists, entrepreneurs, researchers and White House advisors working to re-imagine and re-build OUD treatment in America.
Lead negotiations for hospital and health system contracts.
Prepare contracts, amendments, and rate analyses.
Coordinate with internal departments for contract compliance.
Arizona General focuses on providing healthcare services. The company seems to have a supportive work environment focusing on collaboration, as suggested by the benefits mentioned.
Utilizing healthcare experience to perform audit recovery procedures.
Identifying and validating incorrect claim payments.
Researching reimbursement regulations for claim payment compliance reviews and documentation to support current audit findings.
Cotiviti Healthcare is the payment accuracy expert, working with healthcare organizations to recover money, improve processes, strengthen relationships, and maximize their value. They are a well-established company with competitive pay, opportunities to develop professionally, and excellent benefits.
Independently resolve a broad range of member inquiries across Maven Managed Benefits, fertility programs, and Maven Wallet workflows.
Interpret and clearly explain benefits design, eligibility, and coverage to members, identifying edge cases and ensuring alignment with plan rules.
Manage end-to-end reimbursement and payment workflows, including reviewing documentation, identifying discrepancies, guiding members on next steps.
Maven Clinic is the world's largest virtual clinic for women and families on a mission to make healthcare work for all. More than 2,000 employers and health plans trust Maven's end-to-end platform to improve clinical outcomes, reduce healthcare costs, and provide equity in benefits programs. Maven Clinic is a recipient of over 30 workplace and innovation awards.
Conduct audits of payer processed claims to verify accurate reimbursement.
Conduct post-implementation Care Center audits following the audit policy.
Assist the Manager, RI, in leading initiatives that drive efficiency.
Privia Health is a technology-driven physician enablement company that collaborates with medical groups, health plans, and health systems to optimize physician practices. Their platform consists of scalable operations and cloud-based technology to reduce healthcare costs and improve patient outcomes.
Collect, analyze, and interpret clinical, operational, and financial data to assess payer performance and trends.
Maintain SOPs, payer playbooks, internal how-to guides, and reference materials.
Translate front-line payer knowledge into scalable process improvements.
Spring Health is on a mission to revolutionize mental healthcare by removing every barrier that prevents people from getting the help they need, when they need it. They partner with over 450 companies and provide care for 10 million people.
Source, interpret, and scope new payment integrity policies.
Prioritize policy updates based on savings potential and client impact.
Quantify and communicate policy value through data-driven analysis.
Rialtic, Inc. focuses on healthcare payment expertise, client strategy, and product innovation. They seem to have a culture that values collaboration and impact, although the job post doesn't specify size/employees.
Oversee provider credentialing, provider licensing, payer contracting, and network expansion.
Lead end-to-end provider credentialing, provider licensing and recredentialing for MDs and NPs.
Manage relationships with credentialing and contracting vendors.
Sunrise Group is building the future of sleep health by combining innovative technology with expert care. They are a fast-growing team across the US and Europe, backed by more than $50M (€46M) from leading investors including Amazon’s Alexa Fund, Eurazeo, Kurma, and VIVES.
Support/back up the CSE, Senior CSC and CSC responsibilities
Create and present data for Strategic Business Plans, VALUE Summaries, and Performance Standard reports
Investigate/follow-up if Performance Guarantees are not met and present those results to their assigned clients
Navitus was founded as an alternative to traditional pharmacy benefit manager (PBM) models. They are committed to removing cost from the drug supply chain to make medications more affordable for the people who need them.
Conduct in-depth analysis of claim payments, identifying trends and patterns for cost avoidance through internal and external collaboration.
Ensure medical claims comply with guidelines, contracts, and standards while detecting billing inefficiencies and recommending corrective actions.
Provide data-driven recommendations to management on payment-affecting issues, supporting necessary system and policy updates and provider education.
BCBSRI is dedicated to serving Rhode Islanders by providing access to high-quality, affordable, and equitable care. They actively support associate well-being and work/life balance, fostering a culture of belonging where diverse perspectives are valued and employees are equipped for success.
Assisting with provider credentialing by collecting documentation, entering provider data, submitting required materials to the health plan, tracking completion, and updating internal records.
Maintaining and updating provider records from various sources in internal systems to ensure accuracy and completeness.
Supporting reporting requirements, including completing health plan reports on assigned schedules.
Guidehealth is a data-powered, performance-driven healthcare company dedicated to operational excellence. They aim to make healthcare affordable, improve patient health, and restore fulfillment in practicing medicine for providers. Powered by AI and Healthguides™, Guidehealth builds connections with patients and providers.
Provide accurate assistance to support the administrative needs of Brokers and Admins across phone and email.
Assist with the administrative side of onboarding and system needs for new and renewing Sana plans.
Address and resolve complaints or problems, such as billing discrepancies and coverage denials.
Sana is a health plan solution built for small and midsize businesses — designed around their integrated primary care service, Sana Care. They've been remote-first since day one, with a fully distributed team across the U.S., and value curiosity, ownership, and speed—building in the open, together.
Lead negotiations for new and existing payor agreements.
Develop negotiation strategies informed by market dynamics and data analysis.
Collaborate with cross-functional partners to ensure contracts can be operationalized effectively.
SonderMind provides personalized mental health care, encompassing therapy, medication management, and mindfulness exercises. They leverage digital tools and research to deliver high-quality care and develop thriving practices, combining technology and human connection to drive better outcomes.
Aledade, a public benefit corporation, empowers independent primary care, and is the largest network of independent primary care in the country. They help practices, health centers and clinics deliver better care to their patients and thrive in value-based care, with a collaborative and inclusive remote-first culture.