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.
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.
Interpret federal and state regulations to ensure compliance and drive process improvements.
Analyze data in Excel to identify trends, savings, and process improvements.
SIHO Insurance Services provides health insurance administration and related services, focusing on payment integrity and regulatory compliance. The company operates in a managed care environment and emphasizes collaboration, professionalism, and adaptability among its employees.
Investigate known or suspected fraud, waste, and abuse with high autonomy.
Develop documentation and reports to substantiate findings and support recoupments.
Analyze prior cases to improve preventive identification and meet savings targets.
Oscar is a health insurance company built around a full-stack technology platform and focused on serving members. The company fosters an inclusive culture where employees can be their authentic selves, with a mission to change health care.
Own outcomes measurement and savings analysis to quantify the impact of RightMove's care model on total cost of care and patient outcomes.
Analyze medical claims, referral patterns, and provider performance to identify savings opportunities and guide patients to high-value care.
Communicate findings through executive-ready reports and presentations to support commercial teams and customer stakeholders.
RightMove is redefining musculoskeletal (MSK) care by shifting from fragmented, volume-driven care to a coordinated, expert-led model powered by AI and data. Backed by leading investors and built in partnership with the Hospital for Special Surgery, the company is a rapidly expanding startup with a high-performing team that values impact, direct communication, and collaboration.
Lead external customer audits and utilization management oversight activities as a subject matter expert.
Analyze complex UM data, investigate findings, and prepare evidence-based responses for regulators and accreditation organizations.
Collaborate with operational, technical, and client-facing teams to drive compliance and process improvements.
This company is a healthcare organization specializing in utilization management and regulatory compliance. It operates with a remote team across the United States, fostering a collaborative and improvement-driven culture.
Own claims adjudication, denials management, and EDI workflows to ensure accurate payment and compliance.
Build reporting dashboards and KPIs to track claims performance and drive process improvements.
Collaborate with prior auth, finance, and client teams to close the loop between authorization and payment.
OneImaging is a concierge radiology service that connects patients with a network of over 5,000 vetted providers across 48 states, reducing imaging costs by 60-80%. We are a high-growth company building the infrastructure for fair and transparent medical imaging, with a focus on employer and payer ROI.
Support Medicaid program integrity activities including fraud, waste, and abuse prevention, provider oversight, and compliance monitoring.
Translate claims analytics and audit findings into practical monitoring approaches, system requirements, and corrective action recommendations.
Coordinate with stakeholders, vendors, and project leadership to support reporting, documentation, training, and quality assurance.
BerryDunn is a professional services firm providing tax, advisory, consulting, and attest services to businesses, nonprofits, and government agencies. It is a client-centered, people-first firm focused on learning, development, and well-being.
Own and maintain client-facing reporting that measures cost savings, outcomes, and performance of prior authorization programs across specialty areas.
Build, maintain, and QC actuarial models and methodology behind that reporting, keeping them ready to scale to new clients and lines of business.
Analyze and interpret authorization and claims data to identify trends, key drivers, and opportunities to improve customer value, quantifying the dollar and utilization effect of each.
Cohere Health’s clinical intelligence platform and agentic AI-powered solutions connect health plans’ strategic goals and providers’ needs, optimizing the speed, cost, and quality of care. Backed by leading investors and named to the Inc. 5000 list, the company fosters a supportive, growth-oriented culture with diverse and inclusive teams.
Analyze large US healthcare claims datasets to identify patterns, data quality issues, and product improvement opportunities.
Write and optimize SQL queries for data extraction, profiling, reconciliation, and impact analysis.
Collaborate with product owners, engineering, engagement, and account teams to support validation, testing, and documentation.
Precision AQ is a healthcare data and analytics company that builds data products supporting US healthcare market access and patient outcomes. It operates as part of the Precision Medicine Group, with a collaborative, cross-functional culture focused on delivery and innovation.
Design and maintain complex financial models to track cost-saving initiatives and provide insights.
Perform advanced data analysis to assess prior authorization trends, claims trends, and cost drivers.
Lead post-implementation assessments to measure the impact of cost-saving initiatives and ensure sustainability.
Cohere Health's clinical intelligence platform and agentic AI-powered solutions optimize the speed, cost, and quality of care. The company is a growing organization with a supportive, growth-oriented environment and has been recognized as a top startup.
Deliver recurring and ad hoc Commercial Analytics to measure client value and support reporting.
Partner with Client Success, Commercial, Finance, and Product to turn data into strategic insights.
Improve metric definitions, data quality, and automated workflows to build for scale.
Virta Health is a virtual care company helping people reverse metabolic disease through personalized nutrition and technology. It has raised over $350 million, partners with major health plans and employers, and maintains a remote-first, values-driven culture.
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.
Independently manage Medicare, Medicaid, and TriCare cost reports and coordinate audits.
Lead the annual cost report peer-review process and manage provider appeals.
Collaborate with internal stakeholders and external reimbursement organizations to ensure compliance.
They are a large health system providing patient-focused healthcare services. The organization is collaborative and mission-driven, with a focus on financial sustainability.
Conduct test-vs-control performance analytics for in-store media programs.
Extract and analyze POS datasets using SQL to evaluate brand trends and campaign performance.
Prepare dynamic reports and dashboards to equip sales and client teams with actionable insights.
Avery Dennison is a global materials science and digital identification solutions company providing branding and information solutions. The company employs approximately 35,000 employees in over 50 countries and reported sales of $8.9 billion in 2025.
Review appeals of adverse benefit determinations within federal and state regulatory timeframes.
Apply medical policy, coding guidelines, and contractual requirements to assess coverage decisions.
Collaborate with medical divisions and respond to state insurance department inquiries regarding benefit complaints.
Arkansas Blue Cross and Blue Shield is a health insurance provider serving Arkansas. It is consistently ranked as one of the best places to work in Central Arkansas, with an inclusive culture and an average employee tenure of 10 years.