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Job Details

Eligibility Operations Specialist at Collective Health
San Francisco, CA, US

Collective Health is transforming the way people experience healthcare. We believe that quality and accuracy are paramount to ensuring exceptional member and employer experiences, and are the foundation for analytics that change how we deliver and pay for care. To accomplish this, we are reimagining the operational core of health insurance.


Eligibility flows through and impacts every aspect of the Collective Health platform; each day we process inbound files from our clients to support our internal plan operations and to pass through to our networks and partners. We are looking for an Operations Specialist to be responsible for the operation, quality, and scaling of our inbound eligibility systems. You will be the integral first point of connection for the clients’ data, enabling a critical piece of our day to day operations. Through your experiences at Collective Health, you will be a pivotal part of improving the member and employer healthcare experience.


About you:


Bachelor's degree and 3+ years of work experience, preferably in operations, client services, or at a startup

Meticulous attention to detail and technical acumen (no coding experience required)

Experience with project management, client implementations, and/or issue resolution

Experience with healthcare EDI formats, COBRA, and benefit administration platforms preferred but not required

Strong drive: set and meet aggressive deadlines, work cross-functionally to identify and solve problems, and prioritize work

Demonstrated experience learning large volumes of information quickly, combined with the ability to understand bigger picture

Independence: must be able to build out processes and create structure with minimal guidance

What you'll do:


The Eligibility Operations Specialist will own the success of day-to-day eligibility transactions from your set of clients and their vendors and:


Learn and apply a deep understanding of healthcare EDI specifications, benefit administration/human resource information systems, COBRA requirements, and operational processes

Investigate and resolve daily exceptions and errors, raising to our clients as required

Work closely with Operations, Product, Engineering, and 3rd party partners on improving existing integrations and implementing new integrations (defining requirements, running file testing, etc)

Partner with client success to continuously improve the data at its source, drive client engagement and reporting, and to define the long-term vision for our client products

Prioritize quality and building for scale – our team is growing fast so you’ll need to be ready for new challenges