Operations Manager / Claims Manager

  • Anywhere

ApostropheHC Apostrophe

The healthplan that can fix America.

About Apostrophe

We are building the health plan that can fix America – and we aren’t being tongue and cheek. That’s our battle cry. The largest most innovative self-insured employers have figured out how to cut 40% from their healthcare costs. Our SaaS platform makes their strategies plug-and-play for 30K mid-sized self-insured employers.

We have spent the past year piloting our platform with a group of 20 employers. Our full deployment goes live on January 1st. We are backed by Better.vc, Techstars Ventures and Royal Street Capital. We were part of Techstars Boulder 2017 and are a certified B-Corp (pending).

Make health plan operations work the way you would want it to work for you or a loved one.

Have you ever wished you could trash your legacy system and start over the right way? We need someone who can configure our a claims system to maximize efficiency and accuracy and take it live for our existing school districts and other self-funded employers across the country.

We pay providers based on the Medicare fee schedule or their cash-pay rate. All providers are in-network unless explicitly excluded by the employer. Benefit designs often include value-based components that support good chronic care management.

You’ll serve as the implementation and operations manager for everything that touches the claims system.  You will be there at the beginning.  This is a rare chance to create a high-functioning claims department – one that is both member and provider-centric, compassionate, efficient, and transparent. We want you to build the foundation and grow it with us.

  • You’ll define and document claim configuration requirements – including setting up initial benefit plans and leading end-to-end testing.
  • You’ll go-live with us on January 1 and troubleshoot all claims and operational issues with an eye towards enhancing automation, including provider support, mailroom operations, COBRA administration, client enrollment and invoicing, and customer service claim inquiries.
  • You get to define the right operational metrics and will be responsible for achieving them on an ongoing basis.
  • As we mature, you will load new employer groups and perform claim audits, including thorough root cause analyses, correction, and retesting.
  • You will support reporting and analytics by ensuring data integrity.
  • You will jump in and do whatever it takes to get claims paid timely and accurately.

Is this role right for you?

  • Have you spent years working in the bowels of a bureaucratic claim shop and are ready for something new and empowering?  
  • This position requires leadership, vision, grit, and a get-it-done attitude.
  • You will put your claim configuration and processing experience to work. You will need to have a deep understanding of medical claim coding and Medicare pricing methodologies.  
  • You will handle multiple projects simultaneously. You will take on things you never dreamed you would do.
  • You should be tech-savvy and have strong verbal and written skills to effectively collaborate with other team members and resolve issues.
  • Here are things we value (apostrophehealth.com/values). Do they describe you?

This role can be contract or employee. It’s a mid-level role with an initial salary of $75K. If you are full-time it comes with an early-stage options package, an open time off policy, and can include a tax-friendly healthcare stipend as part of your pay package. Other benefits and opportunities will come as we grow. Our home base is in Denver near Union Station. We split our time evenly between the office and work from home, but are flexible and open to any arrangement.

Apostrophe does not discriminate based on race, color, religion (creed), gender, gender expression, age, national origin (ancestry), disability, marital status, sexual orientation, or military status, in any of its activities or operations. We are committed to providing a welcoming environment for all members of our staff, clients, volunteers, subcontractors, vendors, and clients.

 

To apply for this job email your details to julia@apostrophehealth.com

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