Billing Specialist Associate

About the Role:

Maven is looking for a Billing Specialist Associate who will be a critical member of the Payment Operations team focused on the deeper investigation and resolution of complex payment and billing cases. This person will play an essential role in managing smooth reimbursement processing for members and in resolving payment discrepancies. This role will report to the Manager of Payments.

What You’ll Do:

• • Investigate and resolve escalated cases (reimbursement processing discrepancies, accumulator/cost-share issues, eligibility questions, claims lifecycle and claims adjudication processing questions).
  • Serve as the expert on billing and cost-share determinations: executing backend system corrective actions.
  • Coordinate with internal teams like Member Benefits Services, Adjudication, Payment Operations, Product, Client Success, and Client Operations.
  • Maintain complete, audit-ready documentation on every case.

What You’ll Bring:

• A Bachelor’s degree in Healthcare Administration, Finance, Business Operations, or related field; or equivalent experience preferred.
• 3-6 years of relevant experience in medical billing, health benefits, or payment escalation management.
• Understanding of medical billing, reimbursement processing, insurance claims processing, and revenue cycle management.
• Working knowledge of the payments lifecycle, benefits design, and claim adjudication.
• Familiarity with ticketing tools (Jira, Zendesk) and reporting tools (Google Sheets, Looker).
• Highly detail-oriented and structured, with strong organizational skills.
• Strong critical-thinking skills for root-cause analysis and sound judgment on when to escalate.
• Outstanding verbal and written communication, adept at translating billing and payments data into clear, confident, and definitive recovery plans for all stakeholders.
• Strong cross-functional collaboration internally (with external visibility).
• Comfortable adapting to shifting priorities in a fast-paced environment.
• Creative problem-solver with resourcefulness to drive innovative escalation strategies.