Strategy & Operations Manager - Insurance

The Role

We're looking for a Strategy & Operations Manager, Insurance to investigate, troubleshoot, and resolve the eligibility, benefits, prior authorization, and coverage nuances across patients and health plans. This is detective work: when an order stalls, you trace it back to root cause - a coverage lapse, the wrong plan on file, an MCO carve-out, an entity or NPI mismatch, a documentation gap - and you fix it so it doesn't recur.

You'll report to the Head of Operations and work closely with our RCM, fulfillment, and product teams to keep orders clean, moving, and compliant while we scale across states.

This role offers a unique opportunity to shape insurance operations in a high-growth startup environment, working hands-on with industry leaders and driving impact across our patient population.

Who You Are

• Investigative & Detail-Oriented: You treat a stuck order like a case to crack. You follow the trail through eligibility responses, payer portals, and system flags until you find the real reason - not just the symptom.
• Payer-Literate & Compliance-Minded: You understand how Medicaid, Medicare, and commercial payers actually work - eligibility and benefit verification, prior authorization, plan structures, and coverage rules - and you operate within HIPAA and billing regulations by default.
• Systems-Minded, Not One-Off: You resolve the case in front of you and then build the SOP or flag that stops the next one.
• Collaborative: You partner across RCM, fulfillment, clinical, and product to unblock orders and cut turnaround time.
• Tech-Savvy & Efficiency-Focused: You use tools, portals, and metrics to work faster and catch the patterns people miss.
• Mission-Aligned: You care deeply about healthcare access and getting patients what they need without the wait.

What You'll Do

• Investigate coverage and eligibility: Verify insurance, discover unknown or secondary coverage from patient demographics, and resolve mismatches between eligibility results and order routing.
• Do the detective work: When an order is stuck, trace it to root cause - lapsed coverage, wrong plan, MCO carve-out, entity/NPI mismatch, documentation gaps - and drive it to resolution.
• Own prior authorization: Submit, track, and follow up on prior auths and appeals; keep turnaround tight.
• Work denials and rejections: Resolve them, identify the patterns behind them, and close the gaps that cause them.
• Research payers: Maintain working knowledge of plan structures, coverage policies, and fee schedules across our active and expansion states.
• Build the systems: Develop and maintain SOPs; turn recurring investigations into repeatable, ideally automated, workflows.
• Track & report KPIs: Measure eligibility hit rate, auth turnaround, denial rate, and clean-order rate; prepare reports and surface insights to leadership.

What You'll Bring

• 3+ years in DME or healthcare insurance operations, eligibility/benefits verification, prior authorization, RCM, or medical billing.
• Strong working knowledge of Medicaid, Medicare, and commercial payer rules; DMEPOS experience a strong plus.
• Hands-on experience with eligibility and clearinghouse tools (e.g., Availity, eMedNY, payer portals) and EMR or order-ordering platforms.
• An investigative mindset - you enjoy untangling messy, ambiguous problems and getting to the bottom of them.
• Experience building SOPs and improving processes in a regulated environment.
• Stellar communication and collaboration skills.

Values

• Excellence, Not Perfection - We set a high bar for our work and impact, but we don't get lost in endless polish for polish's sake. We focus on results that matter.
• Urgency, Not Chaos - We move fast because speed drives our advantage. We pair urgency with clarity to avoid noise and burnout.
• Systems, Not One-Offs - Every solution should eliminate the root cause so the problem never returns. Wins are good; scalable systems are better.

• Committed, Not Just Here - We show up engaged, proactive, and ready to go above and beyond.
• It's not about working 24/7 - it's about caring deeply and leaning into our shared mission.
• The outcomes you drive are what matter most.

Crush Goals, Not Souls - We take our work seriously, but not ourselves. Be yourself, bring positivity, have fun, and laugh often.

Compensation & Benefits

• Competitive salary with performance-based incentives.
• Flexible working environment (3 in-office days per week in New York).
• Unlimited PTO + 9 company holidays.
• Direct mentorship and growth opportunities with senior leadership.