Health Plan Operations Associate

Be a part of the team building the future of healthcare!

Firefly Health is building a revolutionary new type of comprehensive health "care and coverage,” powered by a relationship-driven care team, a trusted virtual and in-person clinical network, and our proprietary technology platform.

Founded by experienced clinicians and technology leaders, Firefly Health is on a mission to deliver clinical and financial health through joyful, always there care. We are flipping the script on what it means to be a health plan and actually providing a true health benefit to members.

We are intensely focused on optimizing the physical + mental + financial wellbeing of those who want (and deserve) something better than the status quo. If you are ready to roll up your sleeves and take on our audacious mission, we would love to hear from you.

Your Role

As a Health Plan Associate you will play a critical role in ensuring the smooth resolution of member and provider claims inquiries. This position requires strong attention to detail, a curious and action-oriented mindset, and the ability to take ownership of tasks from start to finish. You will focus on delivering an outstanding customer experience by investigating and resolving claims inquiries within established service level agreements (SLAs). Additionally, you will actively contribute to identifying opportunities for process and technology improvements to enhance operational efficiency and reduce inbound inquiries.

You will:

• Claims Inquiry Management:
• Capture, document, and triage member and provider claims inquiries.
• Investigate and resolve claims issues within SLA, ensuring accurate and timely communication to stakeholders.
• Serve as a point of contact for escalations, ensuring satisfactory resolution and a positive customer experience.
• Customer Experience Excellence:
• Maintain a high standard of professionalism and empathy in all interactions with members and providers.
• Proactively follow up on outstanding issues to ensure resolution and satisfaction.
• Process and Technology Improvement:
• Analyze trends in inbound inquiries to identify root causes and recommend process improvements.
• Partner with cross-functional teams to implement solutions that reduce inquiry volume and improve workflows.
• Provide feedback to enhance tools and systems used for claims management.
• Collaboration and Reporting:
• Work closely with internal teams to escalate and resolve complex issues.
• Prepare regular reports on inquiry resolution metrics and performance against SLAs.

You’d be a good fit if you have:

• Minimum of 2 years of experience working with health plans or in a similar role involving claims management.
• Exceptional attention to detail, ensuring accuracy in capturing and resolving claims inquiries.
• Strong problem-solving skills and a bias towards taking initiative and action.
• Curiosity to understand the root causes of issues and a passion for continuous improvement.
• Excellent communication skills, both written and verbal, with the ability to convey complex information clearly.
• Proficiency with claims systems and a strong aptitude for learning new tools and technologies.
• Ownership mentality, with the ability to see tasks through to completion independently.
• A customer-first approach, with a dedication to providing a superior experience for members and providers.
• Adaptability and willingness to thrive in a fast-paced, dynamic environment.

It’d be nice if:

• You have familiarity with common health plan operations & terms, including claims adjudication, member services, or provider relations.
• You have experience working with process improvement initiatives, such as Lean or Six Sigma methodologies.
• You are very comfortable working with Google Work products including GMail, Google Sheets, Google Slides, Looker, and Google Drive.
• SQL and data analysis experience preferred

Our office is in Watertown, Massachusetts, but we’ve developed a robust remote working structure to give us more geographical flexibility while hiring for many positions. This role can be done largely remotely, there are several times a year when staff come together onsite for planning and team building.

Firefly is an equal opportunity employer. We value diverse backgrounds and perspectives. We're committed to building and sustaining an inclusive workplace culture where individuals are treated with dignity and respect. All employment is decided on the basis of qualifications, merit, and business need. Firefly is an E-Verify employer.

We are always looking for valuable talent to add to our growing team. Even if you’re not sure this role is the one for you, don’t let that stop you. We’d love to have a conversation to see where you could fit.