• Analyze benefit plan documents to accurately build benefit categories and adjudication rules for claims processing • Review member accumulators and assist in loading benefit logic to member and group records • Review and evaluate claims and benefit issues and interpret plan policies • Utilize multiple applications to fulfill job functions across the configuration team • Support cross-functional teams during implementations and renewals • Demonstrate commitment to our core competencies of being authentic, curious, creative, empathetic, and outcome oriented. • Manage daily configuration inventory queues • Complete audits for group and plan builds • Monitor and respond to team mailboxes

• Perform medical and revenue audits to ensure revenue integrity as related to adherence to federal and state regulations, policies of external payers, and coding rules and guidelines. • Exercise independent decisions using analytical and problem-solving skills. • Provides critical analytical and negotiation support with respect to third-party payer reimbursement contracts. • Responsible for conducting quality control audits to ensure data/documentation integrity and communicating findings and recommendations. • Compiles information and/or prepares reports and analyses setting forth results of data integrity findings with appropriate recommendations.

• Own end-to-end COGS and gross margin analysis for Motive’s hardware and software product lines • Model cost-saving opportunities and deliver recommendations on profitability levers • Structure ambiguous, high-stakes business questions and walk into executive conversations with a clear point of view • Partner closely with data engineering, finance, and product teams • Establish ground truth, build reliable datasets, and create durable analytical frameworks • Contribute to the operational rigor of the SA team • Operate with minimal supervision

Role Description The UM Authorization Analyst II is responsible for ensuring the timely and accurate processing of medical procedure authorizations. This role includes: - Reviewing authorization requests - Maintaining compliance with regulations - Coordinating with healthcare providers and insurance companies to support patient care This role can be worked remotely from anywhere in the contiguous United States, and will be working on an Eastern time schedule. Essential Duties and Responsibilities - Leading daily huddles with UM Physician Reviewers to address risks related to timely decision-making and documentation accuracy - Creating, reviewing, and administering corrective action forms with support and guidance from the Director, Utilization Management Compliance - Managing denial and/or appeal escalations and communicating delays to the Director, Utilization Management Compliance - Working closely with the Director, Utilization Management Compliance to identify deficiencies and areas for improvement - Partnering with delegated entities to ensure the accuracy and compliance of provider credentialing processes - Conducting thorough sanction and exclusion checks - Promoting the effective utilization of QuickCap workflows within Utilization Management operations - Preparing and presenting regular reports on authorization activities, including volume, turnaround times, and issues - Identifying and forwarding standard or expedited appeals to the appropriate health plan - Staying current on industry regulations, guidelines, and best practices related to utilization management and review - Participating in monitoring and analyzing Inter-Rater Reliability (IRR) testing, identifying trends, and recommending best practice improvements - Demonstrating expertise in health plan delegation requirements - Ensuring adherence to key performance indicators (KPIs) and service level agreements (SLAs) for all delegated Utilization Management (UM) functions - Performing other duties as assigned to support operational goals - Living and exemplifying TOI core values, providing outstanding customer service and promoting a positive experience for patients and staff members Qualifications - Excellent communication and interpersonal skills - In-depth knowledge of medical procedure authorization processes and healthcare insurance requirements - Ability to analyze data and implement process improvements - Proficiency with medical billing software and electronic health records (EHR) systems - Strong organizational skills and attention to detail - Strong understanding of evidence-based guidelines (MCG, National Coverage Determinations, Local Coverage Determinations) - Understanding of prior authorization regulatory requirements and turnaround time expectations (CMS, AHCA, NCQA, URAC) Requirements - Associate’s degree in health information management, or a healthcare related field (Bachelor’s preferred) - 4-6 years of experience in utilization management - Bilingual in English and Spanish required Physical Working Requirements The position involves prolonged periods of sitting at a desk, extensive computer use, and phone interaction. Additionally, the role may require occasional lifting of up to 20 pounds for office supplies or equipment. The physical demands described above are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. Pay Transparency The estimate displayed represents the typical wage range of candidates hired. Factors that may be used to determine your actual salary may include your specific skills, how many years of experience you have, and comparison to other employees already in this role. Pay Transparency for salaried teammates: $71,000 — $85,000 USD