Reporting to the Manager, Operations Compliance, the Senior Associate, Operations Compliance plays a vital role in ensuring fair and effective resolution of member complaints and appeals within the organization. This position involves carefully reviewing and investigating member's grievances, which may include issues related to products, services, or interactions. The Senior Associate will work closely with various departments to gather relevant information, analyze cases, and own reporting to the California Department of Managed Health Care. The Senior Associate will ensure that the Grievance and Appeals process is transparent, thorough, and timely.

What you'll be doing:

• The role will be responsible for examination of grievances and appeals in the state of California, in addition to other states.
• Consult with our internal Legal department to clarify legal ramifications around complex appeals.
• Gather, document, track and pursue the resolution of grievances in accordance with state department of health regulations.
• Audit grievances and appeals files for completeness and accuracy and investigate deficiencies.
• Identify areas of potential improvement and provide feedback and recommendations to management on issue resolution, quality improvement, policies and procedures, administrative costs, cost saving opportunities, best practices, and performance issues.
• Monitor daily, weekly, monthly, and quarterly reports, ensuring internal & regulatory timeframes are met
• Follow-up with responsible internal departments and stakeholders to ensure compliance.
• Participate in Grievances & Appeals committee meetings.
• Will contribute to the development and improvement of policies and procedures to prevent future grievances.
• Assist with training and guidance to Grievances & Appeals staff as needed.
• Support with additional Operations Compliance initiatives including but not limited to Clinical and Operational Audits.

What we expect from you:

• Bachelor's degree or equivalent experience required
• You have 4+ years of cross-functional experience in a high-growth startup and/or healthcare systems
• You have a strong understanding and knowledge of grievance and appeals regulations.
• You are a top performer and team player who thrives in a culture of collaboration, accountability, and ambiguity.
• You are a master communicator: written, verbal and listening abilities to effectively manage a variety of relationships.
• You are a self-starter who thrives when given autonomy, with proven ability and desire to build effective relationships.
• You have the ability to thrive under pressure and manage/prioritize multiple projects
• Exceptional analytical, attention-to-detail, and organization skills.
• You've demonstrated the ability to generate new and innovative solutions to complex problems incorporating multiple internal and external stakeholder perspectives.
• You embody a member > team > individual perspective
• You value levity, humility, collaboration and deriving fulfillment from success achieved through the work you accomplish with others.
• Bonus: Experience with Grievances & Appeals and Clinical Auditing in a startup setting
• Bonus: Experience working in Jira, Zendesk, and other ticketing systems
• Bonus: Experience working with Looker and other BI tools

The target salary range for this position is $112,500 - $146,250, and is part of a competitive total rewards package including stock options, benefits, and incentive pay for eligible roles. Individual pay may vary from the target range and is determined by a number of factors including experience, location, internal pay equity, and other relevant business considerations. We review all employee pay and compensation programs annually at minimum to ensure competitive and fair pay.

Don't meet every requirement? Studies have shown that women, communities of color and historically underrepresented talent are less likely to apply to jobs unless they meet every single qualification. At Spring Health to building a diverse, inclusive and authentic workplace, so if you're excited about this role but your past experience doesn't align perfectly with every qualification in the job description, we strongly encourage you to apply. You may be just the right candidate for this or other roles!

Ready to do the most impactful work of your life? Learn more about our values, how we work, and how hypergrowth meets impact at Spring Health:

What to expect working here:

• You will be held accountable to an exceptionally high bar and impact
• This may be the fastest work environment you will ever experience in terms of growth, decision-making, and time to impact
• You will be challenged to set and protect your own boundaries
• You will create processes & products that have never existed before
• You will have very direct conversations and receive continuous feedback to push you to become the highest performer you can be
• Change is a constant here: your role, team, responsibilities, and success metrics will shift as the company grows

And...

• You get to be surrounded by some of the brightest minds in the field
• You get to learn and grow at an extremely accelerated pace
• You will experience transparency, integrity, & humility from leadership
• You will be empowered to constantly challenge the status quo
• You get the space to experiment & innovate
• You get to make a transformational impact for the company, mental health, and for real human lives - and you will see that impact quickly
• You will become more resourceful and resilient
• You get to be part of a winning team that opens doors in the future

Benefits provided by Spring Health:

Your Total Health:

• Generous medical, dental, vision coverage available day 1 + access to One Medical
• 20 total yearly no-cost visits to the Spring Health network of therapists, coaches, and medication management providers for you and your dependents
• Flexible paid time off in addition to 12 paid holidays throughout the year
• $500 per year Wellness Reimbursement
• Access to, an on-demand virtual benefit that provides wellbeing coaching, and budget management.
• Spring Health provides access to , a platform with technology-tailored, personalized addiction treatment plans for substance use (*QG is available to benefit-enrolled employees, spouses, and dependents age 18+)
• Sabbatical Leave: When you're a Team Member at Spring Health and hit your four-year Springaversary, you'll be awarded a four week, fully paid, sabbatical leave.

You And Your family:

• 4-4.5 months of fully paid parental leave
• Spring Health provides team members and their families with sponsored access to Bright Horizons child care, back-up care, and elder care.
• Access to is provided by Spring Health. Joshin is a comprehensive support system for disabilities and neurodivergence in the workplace. This benefit supports employees, their families, and our teams through personalized navigation and disability education and training along with a network of screened in-home caregivers with disability and neurodivergent experience.
• Access to fertility care support through , in addition to $4,000 reimbursement for related fertility expenses

Supporting you financially through:

• Our People team benchmarks all salaries using the for technology and life sciences industries. Radford benchmarks salaries with 3,589 global firms, 6.5 million employees, and 98 countries across the globe. We do this to ensure all of our team members are paid equally and competitively.
• On top of competitive and benchmarked salary, Spring Health offers incentive pay (based on role), and equity that begins vesting as we celebrate your first year with the company!
• Employer sponsored 401(k) match of up to 2% after 90 days of employment

Creating a culture you can thrive in:

• Flexible work arrangements: 60% of Spring Health team members work fully remote while 40% work in a hybrid model from our New York City offices
• Focus Fridays: no meetings, no distractions, just time for you to get work done.
• Focus Weeks: In Spring 2023, we held our first ever Focus Week, we canceled all non-essential meetings, minimized distractions, and you, our team members, to dive into the key work that gets chopped up or deprioritized during the regular day-to-day. We saw a 36% jump in the average energized score after those five days of flow state work and are finalizing a plan for quarterly Focus Weeks for team members.
• Up to $1,000 Professional Development Reimbursement per calendar year.
• $200 per year donation matching to support your favorite causes