Resolve denied claims by reviewing supporting documentation, calculating benefits due, and composing appeal letters.
Analyze claims to determine validity of denial/recovery options and draft convincing correspondence to effect reimbursement.
Build relationships with insurance carriers, patients, attorneys, and employers while documenting all actions to resolution.
Xsolis is an AI-driven technology company reducing administrative waste in healthcare by enabling smarter collaboration between providers and payers. Recognized on the Inc. 5000 and Deloitte Technology Fast 500 lists, it is one of the fastest-growing privately-held companies in North America with a passionate, fast-moving culture.
Manage document workflows, including processing, quality assurance, and adherence to internal procedures.
Conduct incoming claim reviews, assign statuses, organize data, and route files to auditors.
Collaborate with internal teams to maintain import queues, reconcile balances, validate charges, and correct errors.
Machinify is a healthcare intelligence company with expertise across the payment continuum, delivering value, transparency, and efficiency to health plan clients. Deployed by over 85 health plans and representing more than 270 million lives, the company uses an AI-powered platform to maximize financial outcomes and drive down healthcare costs.
Process medical claims and appeals accurately and timely, following health plan policies and procedures.
Maintain detailed notes, research claim issues, and communicate outcomes with claimants and teams.
Support customer success teams, escalate operational issues, and help improve claims processes.
Sana is a health plan solution built for small and midsize businesses, with integrated primary care services to make healthcare easy. Founded in 2017, the company is remote-first with a fully distributed team across the U.S., and values curiosity, ownership, and speed.
Provide subject matter expertise on Payment Integrity claims processing edits, vendor edits, and reimbursement policies.
Respond to internal and external inquiries and disputes while documenting industry standard coding rules and recommending policy changes.
Collaborate with partners to scope, prioritize, and deliver solutions using data insights and process improvements.
Oscar is a health insurance company built around a full stack technology platform and a relentless focus on serving members. Founded in 2012, the company fosters a culture of transparency, collaboration, and authenticity as an Equal Opportunity Employer.
Evaluate AI outputs from healthcare documents to identify errors, missing information, and cases needing human review.
Translate insurance requirements into clear workflows, decision trees, and documentation for prior authorization and eligibility verification.
Research payer rules and execute daily AI configuration changes to improve automation and maintain quality standards.
Silna Health helps healthcare organizations prevent administrative issues by simplifying prior authorizations, eligibility verification, and benefit checks. Backed by Accel and Bain Capital Ventures, it serves behavioral, physical, ambulatory, and post-acute care.
Oversee day-to-day claims operations and provide technical leadership to resolve complex issues.
Implement policies and procedures compliant with state and federal regulations to ensure accuracy and timeliness.
Monitor claims quality, identify trends, and drive process improvements for operational excellence.
Centene provides access to high-quality healthcare and innovative health solutions to help people live healthier lives. It values diversity and offers a supportive culture with flexible work options.
Serve as a subject matter expert in initiating Auto and Property claims with precision and professionalism.
Provide clear, expert counsel to customers on coverage, filing options, and the claims process.
Accurately capture First Notice of Loss documentation and coordinate resources to advance claim resolution.
Liberty Mutual is a Fortune 100 insurance company that helps people safeguard their assets and navigate life's uncertainties through a wide range of insurance products. With a large, inclusive workforce, the company values diverse perspectives and supports employees through comprehensive benefits and professional development opportunities.
Manage provider data and generate reports to support network operations and compliance.
Validate and audit provider records to ensure data accuracy and regulatory alignment.
Collaborate with cross-functional teams to resolve configuration issues and support network projects.
This company operates in the healthcare sector, focusing on provider network administration and data management. It fosters a collaborative, detail-oriented remote work environment that values data accuracy and continuous quality improvement.
Resolves medical claims that are not automatically adjudicated, ensuring timely and accurate processing.
Investigates and communicates to obtain needed information, and interprets contract benefits.
Works from home within Arkansas, Washington, Oregon, Utah, Idaho, North Dakota, or Minnesota.
Arkansas Blue Cross and Blue Shield is a health insurance provider that resolves medical claims and supports member health and wellness. The company is consistently ranked as a best place to work in Central Arkansas, with an average tenure of 10 years and an inclusive culture.
Acquire investigative techniques and work with experts to determine accident causes and fault.
Independently manage a claims inventory, including investigations, medical record reviews, and damage evaluations.
Resolve cases by negotiating settlements with individuals or attorneys.
Liberty Mutual is a leading property and casualty insurer helping people embrace today and confidently pursue tomorrow. They are a Fortune 100 company recognized as a Great Place to Work and one of Forbes' best employers for diversity and new graduates.
Maintain workflow balance and accurately complete re-pricing requests within established timeframes.
Apply medical terminology and coding principles to re-price Medicare and Medicaid claims and meet quality assurance goals.
Manage pre-pay edit requests, adjudicate DME claims, scan records, and follow confidentiality guidelines for PHI and HIPAA.
CoventBridge Integrity Systems is a national leader in the fight against healthcare fraud, waste, and abuse, providing investigative services, technology, and expertise to government and commercial healthcare payers. They are an equal opportunity employer committed to inclusion, diversity, and supporting employees with benefits and accommodations.
Serve as the primary point of contact for dental providers and network partners, resolving escalated issues related to claims, credentialing, authorizations, payments, and plan-specific benefit questions.
Act as the bridge between providers and internal operations, claims, and client services teams to resolve issues quickly and prevent repeat problems.
Coordinate with claims, credentialing, contracting, and client services teams to resolve cross-functional issues and support compliance requirements.
NationsBenefits is a Healthcare Fintech provider of supplemental benefits, flex cards, and member engagement solutions that partners with managed care organizations. It is recognized as one of the fastest-growing companies in America with career advancement opportunities across multiple locations in the US, South America, and India.
Analyze and evaluate worker's compensation claim payments using proprietary software and tools.
Research and acquire medical records and submit claims with supporting documentation to insurance companies.
Conduct telephone follow-up with payers to ensure claims are received and facilitate prompt reimbursement.
EnableComp provides Specialty Revenue Cycle Management solutions for healthcare organizations, leveraging a unified platform to improve financial sustainability. The company is a multi-year Top Workplaces award recipient and has been among the fastest-growing private companies in the US for eleven years.
Evaluate, negotiate, and settle low to high complexity bodily injury claims to prevent unnecessary exposure.
Investigate and analyze medical records, law enforcement reports, and witness statements to determine liability and damages.
Coordinate settlement, mediation, and arbitration with attorneys, ensuring compliance with state laws and regulations.
Mercury Insurance helps people reduce risk and overcome unexpected events, providing insurance products and claims services for more than 60 years. They emphasize a collaborative, inclusive culture where team members are encouraged to grow, have fun, and make a meaningful impact.
Acts as a central point of contact and provides analytical problem-solving support to Commercial and Medicare Appeals and Grievances staff.
Researches, analyzes, and implements changes to processing procedures to increase department efficiency and meet regulatory compliance.
Supports training, documentation, and compliance activities while serving as a subject matter expert on appeals module configuration.
Capital Blue Cross is an independent licensee of the Blue Cross Blue Shield Association, providing health insurance and wellness programs. The company fosters a flexible, caring culture and is consistently voted one of the "Best Places to Work in PA."
Monitor and resolve escalated credit balances and refunds from billing system overages.
Review refund request letters and determine appropriate resolutions based on contract and timely guidelines.
Analyze data from reports, identify trends, and ensure refund checks are processed and cleared.
Ventra Health provides revenue cycle management and business solutions for facility-based physicians in specialties like anesthesia, emergency medicine, hospital medicine, pathology, and radiology. They foster a collaborative, team-oriented culture with a focus on transparency, data-driven solutions, and performance-based rewards.
Verifies data from source documents according to established procedures and rules.
Searches entire application while assembling file in a prescribed sequence.
Completes timesheets on a weekly basis.
LexisNexis Legal & Professional provides legal and business information and analytics to professionals. It is a large, equal-opportunity employer with a focus on work-life balance.
Prepare and submit state-level reimbursement disputes through state portals, agencies, and arbitration entities.
Track deadlines, fees, and payments while keeping accurate case records from filing through resolution.
Monitor state requirements, flag rule changes, and collaborate with analytics teams to keep case data clean.
Pivotal Health is the leading technology platform that helps healthcare providers get paid fairly in a complex reimbursement landscape. We are a collaborative, low-ego team building AI-driven solutions to simplify reimbursement workflows.
Conduct investigations and inspections to assess damage, estimate costs, and determine settlement amounts.
Analyze medical, financial, and job information to determine eligibility for benefits based on statutory criteria.
Settle claims in accordance with standards and negotiate with all parties involved to ensure smooth processing.
Desjardins Group is the largest cooperative financial group in North America, offering a full range of financial products and services. With over 52,000 employees and named one of Canada's top employers, they foster a people-first culture and are committed to equity, diversity, and inclusion.