Claims Operations Specialist

Oversee the full revenue cycle process for both medical and pharmacy claims, including submission, QA, payment posting and AR follow-up. Review, investigate and resolve claim denials and rejections to ensure timely and accurate reimbursement. Assist with client onboarding, including claims setup, payer integration, Candid configuration and rules engine alignment. Perform monthly billing operations such as claims reconciliation, bank reconciliation and revenue validation. Serve as a point of contact for clients, participating in onboarding calls, monthly check-ins and responding to billing questions. Collaborate with Sales, Product, Data and Client Success teams on RFPs, internal process updates and issue resolution.