Senior Associate, Claims and Benefits Specialist

Role Overview

The Senior Associate, Claims and Benefits Analyst owns end-to-end member-level billing and reimbursement accuracy, corrections, and escalations. This is a senior operational role responsible for resolving complex billing discrepancies, conducting cross-system investigations, and safeguarding the integrity of cost-share calculations, claims processing, eligibility inputs, and reimbursement workflows.

This role requires advanced analytical rigor, strong systems fluency, and sound escalation judgment. You will partner closely with Payment Operations, Payment Integrity and QA, Engineering, Revenue Cycle Management, Member benefits and external TPAs to ensure billing precision, financial integrity, and member trust. We are looking for a systems-minded expert who can navigate complex resolutions while influencing broader process improvements.

Why This Role Matters

Claims and benefits accuracy directly impacts member trust and financial integrity. In this role, you will have full ownership over complex claims and benefits resolutions while influencing broader process and system improvements. Your work will drive measurable impact on both operational performance and member experience.

What You’ll Do

Own Complex Billing & Reimbursement Escalations

• Manage complex billing cases and reimbursement requests from intake through final resolution.
• Investigate discrepancies related to eligibility, prior authorization, cost-share (copay, deductible, out-of-pocket), accumulators, and denied claims.
• Conduct thorough reviews of reimbursement submissions to identify errors in processing and ensure correct payout amounts and methods.
• Ensure all corrections align with compliance standards, internal policies, and payer requirements.

Conduct Cross-System Investigations

• Analyze claims lifecycle data, eligibility feeds (RTE), accumulator logic, and backend billing workflows.
• Differentiate between one-off errors and systemic configuration or automation issues.
• Escalate infrastructure-level defects with clear documentation and impact analysis.
• Perform end-to-end review and resolution for complex member benefits and claims escalations.
• Engage with Maven members via Zendesk support tickets, emails, reimbursement processing, and other business channels as needed.

Partner Cross-Functionally

• Collaborate with Payment Operations, Revenue Cycle Management, Engineering, Finance, Member Benefits, and external TPAs.
• Serve as a primary point of contact for backend billing adjustments and payer coordination.
• Work with internal teams to provide clear and concise explanations of complex billing and benefits issues.

Improve Processes

• Identify recurring billing defects and operational risk trends.
• Recommend workflow or system improvements to reduce future escalations.
• Contribute to SOP refinement and billing integrity initiatives.

Communicate with Clarity

• Explain billing determinations, denials, and member financial responsibility in a clear, compliant, and empathetic manner.
• De-escalate sensitive disputes while maintaining financial accuracy and professional transparency.

What You Bring

• Experience: 4–5+ years in healthcare billing, claims operations, revenue cycle management, or benefits management.
• Domain Expertise: Deep understanding of claims adjudication, cost-share structures, eligibility verification, and accumulator logic.
• Analytical Rigor: Experience managing complex billing investigations across multiple systems and performing root-cause analysis.
• Systems Fluency: Familiarity with TPA platforms (e.g., Alegeus or similar billing/claims systems).
• Attention to Detail: High precision in reviewing reimbursement payouts and documenting technical discrepancies.
• Judgment: Ability to balance speed, accuracy, and sound escalation judgment in a high-volume, fast-paced environment.

Bonus:

• Specialized Knowledge: A strong understanding of benefits and fertility-specific insurance knowledge (e.g., cycle-based benefits, fertility medications, and specialized diagnostic coding).
• Proven track record of driving automation and workflow enhancements within claims operations and employer-sponsored benefit reimbursement programs.
• Previous experience in a high growth startup environment

The base salary range for this role is $98,000 - $107,000 per year. You will also be entitled to receive equity and benefits. Individual pay decisions are based on a number of factors, including qualifications for the role, experience level, and skillset.

This role requires active work authorization in the US.

Maven embraces a flexible hybrid work model. Our teams primarily operate from the New York Metropolitan area, NY, and remotely via San Francisco/Bay Area, CA, Seattle, WA. For those in our New York City office, we encourage in-person collaboration by requiring team members to work onsite three days a week  (Tuesday, Wednesday, Thursday). For those based in San Francisco/Bay Area, CA, or  Seattle, WA, we encourage in-person collaboration by requiring team members to attend quarterly Work Together Days within these cities. This policy aims to balance remote work flexibility with the benefits of face-to-face interaction.

Maven embraces a flexible and inclusive work environment. This role is open to candidates in: AZ, CA, CO, CT, DC, DE, FL, GA, HI, IL, IN, KS, MA, MD, ME, MI, MN, MO, NC, NH, NJ, NM, NV, NY, OH, OR, PA, RI, SC, TN, UT, VA, VT, WA, WI. Maven is committed to supporting remote team members with the tools and collaborative culture needed to thrive regardless of location. This policy reflects our belief that great work can happen anywhere and that flexibility enables our team to do their best work.