Senior Associate, Claims and Benefits Specialist

Responsibilities

• 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

Benefits

Additional Information

Maven is the world's largest virtual clinic for women and families on a mission to make healthcare work for all of us. Maven's award-winning digital programs provide clinical, emotional, and financial support all in one platform, spanning fertility & family building, maternity & newborn care, parenting & pediatrics, and menopause & midlife. More than 2,000 employers and health plans trust Maven's end-to-end platform to improve clinical outcomes, reduce healthcare costs, and provide equity in benefits programs. Recognized for innovation and industry leadership, Maven has been named to the Time 100 Most Influential Companies, CNBC Disruptor 50, Fast Company Most Innovative Companies, and FORTUNE Best Places to Work. Founded in 2014 by CEO Kate Ryder, Maven has raised more than $425 million in funding from top healthcare and technology investors including General Catalyst, Sequoia, Dragoneer Investment Group, Oak HC/FT, StepStone Group, Icon Ventures, and Lux Capital. To learn more about Maven, visit us 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: 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) TIME 100 Most Influential Companies (2023) Fast Company Most Innovative Companies (2020, 2023) Built In Best Places to Work (2023) Fortune Best Workplaces NY (2020, 2021, 2022, 2023, 2024) Great Place to Work certified (2020, 2021, 2022, 2023, 2024) Fast Company Best Workplaces for Innovators (2022) Built In LGBTQIA+ Advocacy Award (2022) 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.

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