Senior Health Plan Quality Control Associate

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.

As part of the Group Administration team within Health Plan Operations, the Plan Operations team owns specialized processes that require close collaboration with finance, legal, product, and other internal teams. The Plan Operations -- Plan Structure, Launch & Design team (PSL&D) will be responsible for owning and further developing key processes that support and enable the Member Claims team and successful client implementations. PSL&D owns, builds, and maintains Collective Health’s core business logic and system while implementing our clients’ healthcare plans onto the Collective Health platform. 

What you’ll do:

• Be a FT member of the PSLD Structure team.


• Have full familiarity with PSLD workflows in order to provide fully accurate quality assurance guidance and feedback as well providing quality assurance insight for developing projects within the plan operation department ad hoc.


• Responsible for the systematic monitoring and evaluation of the performance of a service to ensure that performance standards are being met, identifying and mitigating risks, reducing costs, and proactively identifying and correcting issues. 


• Oversee and manage the QA team’s performance and assist in developing process improvements, SOPs, metrics, etc to routinely operationalize daily workflows.


• Quality Assurance focuses on prevention, appraisal, internal failure, and external failure while considering customer focus, leadership needs, engagement of people, process improvement, evidence-based decision making and relationship management. 


• Involved in Standard Operating Procedures Disaster Recovery, Backup Plan and Failover Plan and Testing.


• Familiar with the location and in depth knowledge of the content of Knowledge Articles needed to perform assigned Standard Operating Procedures and an ability to train others on the content and its application. 


• Involved in the ongoing review of Knowledge Articles with the responsibility for accuracy training, compliance and ongoing improvements. Industry knowledge of services and regulations.


• Review proposals for improvement and provide support for projects focused on improving Standard Operating Procedures and compliance with internal controls and eternal regulations.


• Maintain and support overall PSLD QA procedures, QA needs along with cross-collaborative project work upon TL approval. 


• Client, partner, and stakeholder facing interactions.

To be successful in this role, you'll need:

• To be self-motivated, intellectually curious, and take ownership for everything you do


• To have Excellent Microsoft Office and/or Google Suites skills, particularly in Excel / gSheets and PowerPoint / Slides


• To have strong analytical thinking and problem-solving skills to collect, organize, analyze, and disseminate information with extreme attention to detail and accuracy


• To have an extensive knowledge and extremely intuitive understanding of QA procedures and attention to detail


• To be CPC or CCS certified or have worked as a Health Plan Benefits Associate II on PSLD for at least 2 years exceeding expectations in your overall workflows, ticket and project management, processes, timeliness, comprehension, team support, etc


• To think critically and are willing to question the status quo in a constructive and thoughtful manner


• To enjoy adding structure & taking a methodical approach to problems


• To be a committed team player


• To thrive on change and are enthusiastic about being along for the ride and learning from our experiences together


• To possess a passion for Collective Health’s mission to transform the health insurance experience for employers and their employees

Pay Transparency Statement

This is a hybrid position based out of our Lehi office, with the expectation of being in office at least two weekdays per week. #LI-hybrid

The actual pay rate offered within the range will depend on factors including geographic location, qualifications, experience, and internal equity. In addition to the hourly rate, you will be eligible for 20,000 stock options and benefits like health insurance, 401k, and paid time off. Learn more about our benefits at https://jobs.collectivehealth.com/benefits/.

Why Join Us?

• Mission-driven culture that values innovation, collaboration, and a commitment to excellence in healthcare


• Impactful projects that shape the future of our organization


• Opportunities for professional development through internal mobility opportunities, mentorship programs, and courses tailored to your interests


• Flexible work arrangements and a supportive work-life balance

We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status. Collective Health is committed to providing support to candidates who require reasonable accommodation during the interview process. If you need assistance, please contact [email protected].

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