Manager, Benefits Workflow & Plan Governance

At Carrum, we live and breathe the mission of transforming the healthcare system to create an unmatched experience for patients. If you are passionate about changing healthcare and want to finally get rid of surprise bills, poor quality, and high prices, while thriving in an entrepreneurial, cutting-edge environment, we would love to connect with you.

In 2014 Carrum reinvented the Centers of Excellence (COE) category in digital health. Today, 90% of the US population lives within 50 miles of a Carrum COE and our providers rank in the top 10% nationally. Our team’s execution has been recognized by the venture community and we’ve raised more than $96M in aggregate from investors like OMERS, Tiger Global Management and Wildcat Ventures. Our impact has been externally proven in a 2021 RAND Corporation study and featured as a Harvard Business School (HBS) case study.

Carrum Health is seeking an inquisitive, process-driven Manager of Benefits Workflow & Plan Governance. This role is for a "systems thinker" who sits within the Legal & Compliance team but lives in the details of cross-functional execution. You will help architect of the rules and workflows that ensure Carrum remains compliant with ERISA and member equity standards while providing a seamless, flexible experience for our members.

You will be responsible for defining the "Rules of Engagement" for complex scenarios—ranging from plan year transitions to high-stakes intake decisions. Your goal is to eliminate ambiguity for our internal teams, ensuring that every member is treated fairly and every plan is administered with precision.

The salary range for this role is $166,000 -$218,000 depending on geography and level of experience, plus equity and an annual bonus.

You’re excited about this opportunity because you will...

1. vFlex Strategy & Exception Lifecycle

• Exception Expiration Framework: Work crossfunctionally to develop and maintain a standardized logic for when and why exceptions expire. This will evolve beyond simple plan-year benchmarks to create a nuanced framework based on:

  • Clinical Necessity: Managing cases where surgical windows or recovery naturally span two plan years.

  • Administrative Delays: Protecting members from expiration when delays are outside their control.

  • Exception Categorization: Defining the difference between a "one-time procedural override" and "ongoing care considerations."

• Member Equity: Ensure that all exceptions are granted based on documented, objective criteria to maintain ERISA compliance and parity across our member base.

2. Primary Payer Integrity & Intake Rules

• Employer Plan Primacy: Serve as the internal champion and enforcer of Carrum’s "Primary Payer" requirement. You will ensure all teams (especially Patient Care and CS) are trained on the mandate that:

  • The employer-sponsored plan must be the primary payer.

  • Carrum does not support Medicare, Medicaid, or other government-sponsored claims.

• Non-Primary Intake Protocols: Codify the process for handling inquiries related to Workman’s Compensation and Automotive Accidents, ensuring these cases are identified and redirected appropriately before they enter the Carrum ecosystem.

3. Clinical Integrity: The "Second Consult" Policy

• Consultation Governance: Design and document the workflow for members seeking a second consult through Carrum after being deemed a "non-surgical candidate."

• Conflict Resolution: Establish clear guidelines for the Patient Care, Operations and Provider teams on how to communicate these denials empathetically while maintaining the clinical integrity of our Centers of Excellence (COE) decisions.

4. SPD Governance & Document Alignment

• Plan Document Maintenance: Assist in the ongoing review and update of Carrum’s SPD (Summary Plan Description) language across the employer client base.

• Consistency Oversight: Ensure that all SPD updates accurately reflect current voluntary and vFlex capabilities, exception protocols, and primary payer requirements.

• Client Alignment: Partner with Client Success to ensure that as we evolve our product and policies, the legal plan documents for each employer stay current and compliant with our operational reality.

Cross-Functional Collaboration

• Patient Care: Create the decision trees and scripts used during intake to identify non-primary payers or unauthorized second consult requests.

• Client Success (CS): Provide the "Playbook" for how we handle vFlex exceptions so they can set clear expectations with employer clients.

• Health Plan Team: Ensure our workflow logic mirrors the Coordination of Benefits (COB) and rules of engagement with the various health plan partners (if applicable)

• Legal & Compliance: Regularly audit workflows to ensure "flexibility" doesn't create regulatory risk or violate member equity.

• Provider Teams: Align with COEs on our exception and consult rules to prevent billing friction and maintain clinical standards.

We’re excited about you because…

• The "Inquisitive" Mindset: You aren't satisfied with "that’s how we’ve always done it." You want to dig into the process to find a more efficient, compliant way.

• Experience: 5+ years in Healthcare Operations, Benefits Administration, or a Governance/Compliance role.

• ERISA Fluency: A strong understanding of the spirit of ERISA, particularly regarding member equity and plan documentation.

• Operational Design: Proven ability to take a complex policy and turn it into a simple, executable workflow for a front-line team.

• You understand that "Compliance" isn't just about saying "no"—it's about building the tracks so the train can go as fast as possible without derailing. You help Carrum scale by turning complex "what-ifs" into clear, repeatable processes.

• Communication: Ability to act as a "translator" between the rigid requirements of Legal and the fast-paced needs of Client Success and Patient Care.

Why you’ll love working with us...

• We’re a hard-working, humble, and compassionate group motivated to solve the hard problems in healthcare today. You’ll work with talented, experienced co-workers from companies like Booz & Company, Livongo, 98point6, Google, and Optum. We believe in using data to inform decisions, technology to make our jobs easier, and creative thinking to pave the future.

• We are working with some of the most recognized and esteemed names in the country. Top hospitals like Johns Hopkins, Mayo Clinic, Stanford Health Care, Scripps Health, and Rush Health have joined our platform. Employers who use our benefit include US Foods, United Airlines, and large public sector organizations like the self-insured schools of California, and the State of Maine.

• We empower team members to be autonomous and provide a collaborative environment where you get support and healthy feedback. You can bring your authentic self to work every day and are encouraged to help others do the same.

• We carve out time to let go of work to celebrate our successes and have fun. We’re a remote-first company with employees all over the United States and two office locations in San Francisco and Chicago. We support our employees during the work day and beyond with flexible working hours, generous time off, paid parental leave, and opportunities to connect with coworkers both virtually and in-person.

• We embrace our team’s diversity of thought, experience, and interests and know that doing so makes us stronger as a company. Carrum has an active employee-led Diversity, Equity, Inclusion, and Justice (DEIJ) committee and several employee resource groups (ERGs). Our ERGS help employees build stronger connections through social, educational, and community activities.

• You’ll feel proud that the work you do each day directly impacts people’s lives in big and meaningful ways.

Other benefits:

• Stock option plan

• Flexible schedules and remote work

• Chicago and San Francisco offices available

• Self-managed vacation days, within reason

• Paid parental leave

• Health, vision, and dental insurance

• 401K retirement plan

About Carrum

We’re a health tech company that brings value-based care to the masses. We help employers deliver a memorable patient experience, immediately lower healthcare costs, and drive better outcomes and achieve this through the power of technology and human-centered design. Since launching in 2014, we’ve partnered with Fortune 500 employers and top hospitals across the nation. We’ve been recognized by Harvard Business School and featured in TechCrunch, The Los Angeles Times, Washington Post, and Modern Healthcare. We believe we’re only scratching the surface of our opportunity and we’re looking for incredible people like you to help us realize our full impact.

Carrum Health is an equal opportunity employer and encourages all applicants from every background and life experience.