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• Responsible for the review and processing of claims within the claims transactional system, according to plan benefits and contractual reimbursement terms.
• Follows established policies and procedures to pay, pend for additional information, or deny claims.
• Accountable to meet and maintain established department production and quality standards.

Evry Health is on a mission to bring humanity to health insurance by expanding benefits, increasing access and transparency, and featuring a personalized, human approach. Evry Health is the major medical division of Globe Life (NYSE:GL) with more than 3,000 corporate employees and 15,000 agents.

• Interpret medical rules, regulations, fee schedules, and edits that payers post.
• Understand and manipulate payer data to build federal, state, and commercial coding and financial tables.
• Maximize the efficiency and use of product solutions by properly maintaining payer specific edits.

Experian is a global data and technology company, powering opportunities for people and businesses around the world. They operate across a range of markets and have an amazing team of 25,200 people in 32 countries.

• Support medical policy functions by providing medical coding and system configuration support.
• Perform coding analyses and utilization reporting to recommend medical policy updates.
• Participate in cross-functional meetings to align with enterprise strategic priorities.

Wellmark is a mutual insurance company owned by policy holders across Iowa and South Dakota, built on over 80 years of trust. Motivated by the well-being of members, they are committed to service, sustainability and innovation.

• Responsible for processing insurance claims accurately and efficiently.
• Analyze claim data to identify trends, errors, and potential irregularities.
• Serve as a liaison between departments to support seamless claims resolution and continuous process improvement.

Curana Health is dedicated to radically improving the health, happiness, and dignity of older adults. They are a fast-growing company serving over 200,000 seniors in 1,500+ communities across 32 states.

• Research and document new payment integrity concepts by analyzing medical policies, billing regulations, and reimbursement logic.
• Translate complex billing rules into precise technical specifications for automated claim auditing algorithms.
• Conduct hands-on data analysis using Microsoft Excel to explore datasets and quantify savings potential for clients.

Cohere Health's clinical intelligence platform delivers AI-powered solutions that streamline access to quality care by improving payer-provider collaboration, cost containment, and healthcare economics. They work with over 660,000 providers and handle over 12 million prior authorization requests annually. The Coherenauts who succeed here are empathetic teammates who are candid, kind, caring, and embody their core values and principles.

• Accurately translate patients’ medical records into standardized codes for diagnoses and treatments.
• Ensure compliance with legal, regulatory, and organizational standards.
• Ensure claims are processed correctly and on time through clear communication and efficient management of records.

Dignity Health Medical Foundation provides comprehensive health care services. They have care centers throughout California and are affiliated with Dignity Health, one of the largest health systems in the nation. They strive to create purposeful work settings where staff can provide great care, while advancing in knowledge and experience through challenging work assignments and stimulating relationships.

• Provide clinical leadership and subject-matter expertise to support analysis and configuration of medical policy content within claims processing systems.
• Ensure accurate implementation of medical policies, review criteria, and authorization requirements while maintaining system infrastructure integrity.
• Serve as an expert resource for medical policy configuration and PGE coding, mentoring Coding Specialists and providing training to operational partners.

Wellmark is a mutual insurance company owned by policy holders across Iowa and South Dakota. We are motivated by the well-being of our members, not profits, and we are committed to sustainability and innovation.

• Submit clean, timely claims with accurate CPT, HCPCS, ICD-10 codes, and modifiers.
• Review provider documentation and assign accurate codes per ICD-10-CM, CPT, and HEDIS/quality reporting guidelines.
• Maintain and contribute to the internal billing rules matrix (payer, state, provider type, modifiers).

Imagine Pediatrics is a tech-enabled, pediatrician-led medical group that reimagines care for children with special health care needs. They deliver 24/7 virtual-first and in-home medical, behavioral, and social care. They enhance existing care teams with compassion, creativity, and an unwavering commitment to children with medical complexity.

• Facilitate client calls related to contracting and payer enrollments.
• Run and analyze client KPIs, providing regular reports.
• Manage the full contracting and payer enrollment process.

Experity transforms on-demand healthcare across the U.S. by empowering urgent care clinics with industry-leading software. The company fosters a team-first culture with opportunities for flexible work and career development.

• Lead client onboarding and coding integration programs, ensuring smooth transitions and long-term operational success.
• Oversee outpatient and physician coding operations, ensuring accuracy, compliance, and productivity.
• Partner with teams to align coding practices with revenue cycle objectives and drive performance improvements.

Jobgether uses AI-powered matching to connect candidates with hiring companies. They focus on efficient, objective candidate evaluation and data privacy compliance.

• Accurately codes and abstracts outpatient medical records utilizing ICD-10-CM and CPT-4 coding systems.
• Assigns modifiers when appropriate.
• Must be able to maintain a minimum 95% coding accuracy.

Montefiore St. Luke’s Cornwall (MSLC) has been a cornerstone of high-quality healthcare in Orange County for 150 years. MSLC is a member of the Montefiore Health System and provides care to more than 250,000 patients annually; it strives to be the employer of choice by offering comprehensive benefit packages.

• Partner with Clinical, Claims, and Payment Integrity peers to review claims for DRG related issues on a prospective and retrospective basis that drive inaccurate payments to providers.
• Proactively identify overpayments to ensure accurate claims payments on inpatient services.
• Participate in collaborative discussions with MDs to verify the clinical rationale behind billed procedures.

Clover Health is reinventing health insurance by combining the power of data with human empathy to keep its members healthier. They have created custom software and analytics to empower their clinical staff to intervene and provide personalized care to the people who need it most.

• Analyzes and answers inquiries regarding pharmacy claims adjudication.
• Adjudicates pharmacy claims and processes pharmacy claims for payment.
• Performs varied activities and moderately complex administrative/operational/customer support assignments.

Humana is committed to helping people live healthy lives, creating personalized experiences, and working collaboratively. They offer medical, dental, and vision benefits, a 401(k) retirement savings plan, and paid time off.

• Codes and abstracts patient encounters for diagnostic and procedural information, analyzing data for reimbursement needs.
• Completes final checks on charts ensuring all reports are signed and NCCI edits, CMS, and Joint Commission rules are followed.
• Participates in continuing education and communicates with the Manager on training needs.

Plumas District Hospital provides essential health care services to the Quincy, California area and surrounding mountain community. With a population of 5,000 residents, PDH offers an inclusive work environment, competitive compensation, and perks like shift differentials and holiday pay.

• Analyze Auto Bodily Injury and Property Damage claims on behalf of clients to determine benefits due.
• Ensure ongoing adjudication of claims within service expectations and industry best practices.
• Negotiate settlement of claims within designated authority and communicate claim activity with the claimant and the client.

Sedgwick is the world’s leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape.

• Audit behavioral health documentation and coding (ICD-10-CM and CPT) for accuracy, compliance, and completeness.
• Deliver actionable feedback to providers, educating on coding and documentation guidelines.
• Serve as a subject matter expert by answering coding-related questions and supporting internal teams.

Headway is building a new mental healthcare system from the ground up—one that’s accessible, effective, and built to scale. They have over 75,000 providers across all 50 states running their practice on their software, serving over 1 million patients.

• Interpret health record documentation using ICD-10 and CPT 4 coding systems for diagnoses and procedures.
• Assign and sequence codes accurately, reconcile edits, and maintain 95% coding quality.
• Act as a key liaison for physicians on coding compliance and documentation improvement.

Shriners Children’s is an organization that provides excellence in pediatric specialty care, multi-disciplinary education, and research with global impact. Named the 2025 best mid-sized employer by Forbes, they foster a learning environment that values evidence-based practice and critical thinking.

• Review clinical documentation and diagnostic results to extract data and apply appropriate ICD-10-CM and ICD-10-PCS codes for various purposes.
• Abide by the Standards of Ethical Coding and official coding guidelines, staying updated on coding changes and interpretations.
• Perform detailed reviews of Inpatient records, assign diagnosis and procedure codes, and meet established productivity guidelines with high accuracy.

Rochester Regional Health is an integrated health services organization serving the people of Western New York, the Finger Lakes, St. Lawrence County, and beyond. The system includes nine hospitals; primary and specialty practices, rehabilitation centers, ambulatory campuses and immediate care facilities; innovative senior services, facilities and independent housing; a wide range of behavioral health services; and Rochester Regional Health Laboratories and ACM Global Laboratories, a global leader in patient and clinical trials.

• Review and analyze insurance denials using EOBs, payer correspondence, and claims data to determine appropriate resolution strategies.
• Differentiate between clinical and technical denials and identify required next steps for appeals or reprocessing.
• Prepare and submit appeals using supporting documentation such as medical records, appeal letters, and clinical justification when necessary.

Jobgether is an AI-powered job matching platform that connects candidates with hiring companies. They use automated technology to review applications and share top-fitting candidates directly with employers, ensuring a fair and efficient hiring process.