Senior Specialist, Process improvement (SIU)

Hi, we're the company. We're hiring a Senior Specialist, Process improvement (SIU) to join our SIU team.

The company is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started the company in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family.

About the role

This Senior Specialist, Process improvement (SIU) is responsible for supporting process improvement and issue resolution in the company Special Investigations Unit (SIU) for all the company Insurance business. The Senior Specialist, Process Improvement role organizes, scopes, triages, investigates and/or executes on solutions and process improvements. You will accomplished by leveraging a deep understanding of the company's SIU, claim infrastructure, workflows, workflow tooling, platform logic, data models, etc., to work cross-functionally to understand and translate friction from stakeholders into actionable opportunities for improvement.

You will report into the Director, SIU.

Work Location: This position is fully remote and open to candidates residing in the U.S., excluding Alaska; Delaware; Hawaii; Louisiana; Montana; North Dakota; Oklahoma; West Virginia; Wyoming; and U.S. Territories. Daily work is completed from your home office, with occasional travel required for team meetings and company events. #LI-Remote

Pay Transparency: The base pay for this role in the states of California, Connecticut, New Jersey, New York, and Washington is: $75,348 - $98,894 per year. The base pay for this role in all other locations is: $67,813 - $89,005 per year. You are also eligible for employee benefits, participation in the company's unlimited vacation program and annual performance bonuses.

Responsibilities

• SIU Operations & Incident Response: Conduct Special Investigations Unit (SIU) intake, triage, and tip research. Support operational goals by providing rapid root cause analysis and training for escalated issues.

• Risk Mitigation & Problem Resolution: Identify operational risks in coordination with leadership, investigating and resolving issues to inform short-, medium-, and long-term technology-driven solutions.

• Stakeholder Feedback & Solutions: Scope, prioritize, and deliver effective solutions based on internal and external partner feedback regarding adverse claim outcomes.

• Data Analysis & Technical Requirements: Use data analysis tools to produce quantitative insights, translating findings into detailed technical business requirements for cross-functional partners.

• Proactive Improvement: Leverage insights from partner submissions, data mining, and process monitoring to identify and address systemic areas of opportunity.

• Operational Organization: Maintain accurate records in accordance with the organization's retention policies, ensuring files are securely stored and accessible. Support consistent team organization through clear documentation, standardized filing practices, and routine upkeep of the shared systems.

• Project & Process Management: Coordinate key projects to meet service level agreements and milestones, supporting financial discipline, quality, and continuous improvement.

• Cost Optimization & Compliance: Partner with leadership and cross-functional teams to implement initiatives aimed at reducing overall costs, enhancing outcomes, and ensuring compliant business operations.

• Stakeholder Communication: Maintain transparency by keeping key stakeholders informed of project progress, status updates, and blockers.

• Compliance with all applicable laws and regulations

• Other duties as assigned

Requirements

• A Bachelor's degree or 4+ years of commensurate experience

• 2+ years experience in a technical role (QA analyst, PM, operations analyst, finance, consulting, industrial engineering) or a process improvement role (Six Sigma or similar)

• 2+ years of experience working with large data sets using excel or a database language

• 1+ years experience deriving business insights from datasets and solving problems

• 1+ years experience improving business workflows and processes

• 1+ years experience collaborating with internal and/or external stakeholders

Bonus points

• An academic and/or professional background in engineering, data, or healthcare

• Experience in a professional healthcare claims organization

• Experience working in or with an SIU

• Knowledge management, training, or content development in operational settings

• Process Improvement or Lean Six Sigma training aids

• Experience using SQL

This is an authentic the company job opportunity.

At the company, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives.

Pay Transparency:  Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements.

Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts.

Reasonable Accommodation: the company applicants are considered solely based on their qualifications, without regard to applicant’s disability or need for accommodation. Any the company applicant who requires reasonable accommodations during the application process should contact the company Benefits Team [link for members] to make the need for an accommodation known.

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