Convert raw medical claims (837 EDI, UB-04, CMS-1500) into canonical models applying healthcare coding standards.
Perform data quality audits and write SQL/Spark SQL queries to validate pipeline output and detect overpayment patterns.
Act as SME on claims coding, adjudication rules, and payer policy, mentoring analysts and collaborating with cross-functional teams.
Machinify is a healthcare intelligence company that delivers value, transparency, and efficiency to health plan clients across the US. Deployed by over 85 health plans and representing more than 270 million lives, the company combines an AI-powered platform with industry expertise to maximize financial outcomes and reduce healthcare costs.
Perform line-by-line review of high-dollar facility itemized bills and claim forms to identify billing errors.
Apply coding and reimbursement expertise to validate accuracy and ensure claims are paid correctly.
Serve as a subject matter expert for complex billing issues and drive payment integrity improvements.
Oscar is a health insurance company built on a full-stack technology platform with a focus on serving members. Founded in 2012, it fosters a culture of transparency and collaboration, working to change health care.
Source and author editing content, translating coding rules and reimbursement policy into precise, testable logic.
Validate content with claims data, sizing opportunities and measuring accuracy, hit rates, and savings.
Partner with Product, Data Science, and clients to turn content concepts into clear requirements and defendable documentation.
Machinify is a healthcare intelligence company that uses an AI-powered platform to maximize financial outcomes and reduce healthcare costs for health plans. Deployed by over 85 health plans representing more than 270 million lives, it fosters a culture of innovation, transparency, and efficiency.
Investigate potential payment inaccuracies using Medicare Advantage claims and reimbursement knowledge to interpret data and explain payment outcomes.
Review claims populations identified through SQL analysis, distinguishing supported discrepancies from exceptions and correctly adjudicated claims.
Document validated findings clearly and support downstream recovery, Compliance/Legal review, and recurring audits.
Clover Health provides healthcare plans for seniors, using data and technology to improve care and lower costs. The company is a remote-first, mission-driven organization focused on diversity and inclusion.
Analyze hospital claims to identify discrepancies between expected and actual insurance reimbursements.
Investigate underpayments and payment variances by examining coding errors, billing discrepancies, and payer policies.
Collaborate with insurance carriers and internal stakeholders to resolve billing issues and improve revenue recovery outcomes.
This partner company specializes in healthcare revenue integrity, helping hospitals recover appropriate reimbursement for services. The team fosters a collaborative, inclusive culture focused on continuous improvement and professional development.
Review and verify healthcare claims for accuracy, coding, eligibility, and coverage.
Approve or deny claims according to policy terms and regulations, and resolve discrepancies.
Process claims efficiently, meet performance targets, and maintain accurate records.
Blue Cross and Blue Shield of Kansas is a health insurance company providing coverage to Kansans. With over 80 years in the community, it fosters an inclusive, family-first culture and supports professional growth.
You'll be the first intake for payor eligibility inquiries, handle CS tickets and calls, and pull claims data to root-cause issues.
You'll run the ineligible claims review, determine which flags are truly ineligible or product defaults to correct, and communicate outcomes.
You'll fix problems at the source by documenting recurring patterns, building CS-facing materials, and owning eligibility-risk dashboards.
Pivotal Health is a technology platform that helps healthcare providers get paid fairly in a complex reimbursement landscape by simplifying IDR workflows with AI-driven software, data, and service. The team is collaborative and low-ego, building solutions for reimbursement clarity, with a mission to make healthcare reimbursement fairer for providers.
Coordinate denial and appeal follow-up activities to ensure timely resolution of insurance denials and appeals.
Investigate payment issues with insurance carriers, maintain tracking systems, and document follow-up actions.
Analyze performance data and collaborate with revenue integrity teams to improve billing accuracy and recovery.
This healthcare organization specializes in pediatric care and research, focusing on operational excellence. The team fosters a collaborative culture centered on quality, accountability, and continuous improvement.
Track MSSP performance metrics including attribution, cost, utilization, and quality.
Build actionable analytics and HCC risk models to identify spend anomalies and performance gaps.
Collaborate with ACO leaders and IT to translate data insights into strategic decisions.
Privia Health is a technology-driven physician enablement company that partners with medical groups and health plans to improve patient care and practice performance. Led by industry talent and physician leadership, it focuses on reducing healthcare costs and advancing value-based care.
Leads cross-collaboration on problem definition, acute error remediation, and root cause solution development
Utilizes data to drive business decisions and impact cross-functional strategy
Develops trusting relationships with internal and external stakeholders through effective communication and collaboration
Oscar is a health insurance company built around a full-stack technology platform, focused on serving its members. We started in 2012 to create a better health insurance experience, and we value authenticity, belonging, and support.
Adjudicate healthcare claims based on client-specified guidelines and determine appropriate payment for services.
Meet productivity, financial accuracy, and procedural standards while mentoring junior team members.
Collaborate on special projects including process documentation, training, quality audits, and surge activity.
HealthEdge provides AI-powered operational infrastructure for health insurance companies, helping them modernize operations and compete effectively. The company is expanding and investing in its people, fostering a collaborative and growth-oriented culture.
Receive medical claims from healthcare providers or patients and verify supporting documentation to ensure completeness.
Interpret Explanation of Benefits (EOB) and CMS-1500 forms, then evaluate claims against program-specific business rules for approval or rejection.
Provide support to customer inquiries via phone, email, or fax while maintaining HIPAA compliance and meeting daily productivity goals.
IQVIA is a leading global provider of clinical research services, commercial insights, and healthcare intelligence to the life sciences and healthcare industries. With operations in over 100 countries, they cultivate a diverse, collaborative culture focused on improving patient outcomes.
Post payments, adjustments, and denials from ERAs, EOBs, and lockbox files into customer PM systems.
Balance daily batches, reconcile to bank deposits, and resolve missing or mismatched ERAs.
Flag underpayments and denials, resolve unapplied cash, credit balances, refunds, and transfer balances.
Amperos is healthcare's first AI-native denial management and revenue recovery platform, using agentic AI to resolve claims end-to-end. Backed by a $16M Series A, it remains a small, early-stage team tackling a $260B+ problem with a mission-driven culture.
Manage the full lifecycle of PIP and Medical Payments claims, from coverage verification and investigation to settlement or denial.
Apply medical cost-containment strategies, coordinate experts, and identify subrogation opportunities while meeting compliance standards.
Work remotely within the US, maintaining accurate claim files and communicating professionally with claimants and stakeholders.
Jobgether is an AI-powered job matching platform that connects candidates with hiring companies. The partner company is seeking a remote Associate PIP Claims Rep to handle Personal Injury Protection claims across multiple states in a structured, compliance-focused environment.
Analyze, research, and resolve issues related to the creation and submission of paper and electronic claims.
Monitor claim errors, identify opportunities for new edits, and collaborate with the Business Systems Department to implement clearinghouse edits.
Validate daily imports, balance hash totals, and report system issues to IS to ensure timely resolution.
Pediatrix Medical Group is one of the nation’s largest providers of prenatal, neonatal and pediatric services, led by physicians. They offer a diverse range of opportunities, competitive salaries, and a commitment to clinical excellence, focusing on a team approach to improve patient lives.
Conduct internal and external quality audits for ICD-10 code abstraction and identify clinical documentation improvement opportunities.
Mitigate risk by validating Encounter Data Gathering Environment Server (EDGE) data and reviewing Risk Adjustment coding performance.
Maintain compliance with national coding standards and support CMS and Risk Adjustment Data Validation audits.
Oscar is a health insurance company built around a full-stack technology platform and a relentless focus on serving its members. Founded in 2012, it cultivates an inclusive environment where employees can be their authentic selves.