Payment Operations Associate

Maven Clinic is the world's largest virtual clinic for women and families on a mission to make healthcare work for all of us. Through Maven Enterprise, the company partners with more than 2,300 employers and health plans to provide end-to-end women's and family health programs spanning fertility and family building, maternity and newborn care, parenting and pediatrics, and menopause and midlife — improving clinical outcomes, reducing healthcare costs, and expanding equitable access to high-quality care at scale. Through its consumer platform, Maven provides direct access to virtual care across 30+ specialties, as well as dedicated hormone and GLP-1 care programs purpose-built for women. Founded in 2014 by CEO Kate Ryder, Maven Clinic has raised more than $425 million from leading healthcare and technology investors including General Catalyst, Sequoia, Dragoneer Investment Group, Oak HC/FT, StepStone Group, Icon Ventures, and Lux Capital. Recognized for innovation and industry leadership, Maven has been named to the TIME100 Most Influential Companies, CNBC Disruptor 50, Fast Company's Most Innovative Companies, and FORTUNE Best Places to Work. Learn more at mavenclinic.com

An award-winning culture working towards an important mission –  Maven Clinic is a recipient of over 30 workplace and innovation awards, including: 

• TIME 100 Most Influential Companies (2023, 2026)
• Fortune Change the World (2024)
• CNBC Disruptor 50 List (2022, 2023, 2024)
• Fortune Best Workplaces for Millennials (2024)
• Fortune Best Workplaces in Health Care (2024)
• Fast Company Most Innovative Companies (2020, 2023)
• Fortune Best Workplaces NY (2020, 2021, 2022, 2023, 2024)

As an Associate, Payments [RCM] at Maven, you will:

• Review and process complex claims related to Maven's fertility treatments, procedures, applicable medications, and expenses tied to additional paths to parenthood, in accordance with company policy and benefit plan designs

• Review claim to Identify instances of denials, underpayments, overpayments

• Prepare and submit timely, well-documented appeals and reconsiderations to insurance payers for expedited re-processing of claims

• Communicate directly with insurance representatives to follow up on appeals and resolve claim issues

• Identify patterns or trends in denials and escalate systemic issues to management

• Verify member eligibility and benefits ahead of and during claims processing

• Resolve eligibility discrepancies between payer records and member/benefit plan data

• Coordinate prior authorizations where applicable to fertility treatment coverage