Collective Health offers the first integrated solution that empowers employers to administer plans, manage costs, and take care of their people—all in one place. Backed by NEA, SoftBank VF and GV.
About the role
This role requires deep technical knowledge of end-to-end claims adjudication, EDI transactions, benefit hierarchy, health plan configuration, and claims system logic. The ideal candidate can independently identify systemic gaps, translate complex operational issues into actionable technical requirements, and partner with Product and Engineering to drive sustainable solutions. Found on 1752vc Careers, the job board for startup and VC roles.
What they're looking for
- 10+ years of experience in health insurance operations, third-party administration (TPA), or health plan claims systems, including direct management experience or equivalent practical experience
- EDI & Claims Systems Expertise: Strong technical understanding of EDI 837 transactions, clearinghouse exchanges, file ingestion, system coding and logic, and error resolution
- End-to-End Adjudication Knowledge: Demonstrated expertise in claims adjudication workflows, benefit hierarchy, health plan configuration, pend rules, and identifying systemic processing gaps
- Accumulator Operations: Experience with accumulator reconciliation, cross-benefit transfers, over-accumulation research, and synchronization
- Technical Problem-Solving: Ability to independently diagnose complex system defects, identify root causes, and translate findings into actionable solutions for Product and Engineering
- Cross-Functional Collaboration: Experience partnering with technical and operational stakeholders to prioritize system improvements, resolve defects, and reduce manual processing
More about this role
At Collective Health, we’re transforming how employers and their people engage with their health benefits by seamlessly integrating cutting-edge technology, compassionate service, and world-class user experience design.
Collective Health is reimagining health benefits through technology-driven, member-focused healthcare administration. We are seeking an experienced Senior Manager, Claims Systems to lead the specialized teams responsible for Accumulator Operations, EDI 837 Ingestion & File Resolution, and Claims Performance & Resolution (CPR).
This role requires deep technical knowledge of end-to-end claims adjudication, EDI transactions, benefit hierarchy, health plan configuration, and claims system logic. The ideal candidate can independently identify systemic gaps, translate complex operational issues into actionable technical requirements, and partner with Product and Engineering to drive sustainable solutions.
- EDI 837 Ingestion & File Resolution: Oversee institutional and professional claims transactions (837I/837P), investigate ingestion rejections, resolve return file errors, and maintain data integrity across claims processing workflows.
- Accumulator Operations: Lead...
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