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.
Own the weekly fee-refund cycle, matching remit amounts and escalating discrepancies to Finance.
Field refund inquiries from Client Success and track missing or delayed refunds.
Maintain Payor Compliance SOPs and flag systemic payment issues to engineering.
Pivotal Health is a technology platform that helps healthcare providers get paid fairly in a complex reimbursement landscape. It is a collaborative, low-ego team on a mission to make healthcare reimbursement fairer for providers.
Triage and resolve data quality issues across 1,200+ payer data feeds.
Collaborate with internal teams and payers to ensure end-to-end data integrity.
Maintain SOPs and lead cross-functional data initiatives to optimize processes.
Aledade PBC empowers independent primary care practices to thrive in value-based care. Founded in 2014, it is the largest network of independent primary care in the country with a collaborative, inclusive, and remote-first culture.
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.
Own claims tracking, provider activation support, and reporting to keep field teams focused on provider relationships.
Monitor payment exceptions, contract signature workflows, and activation milestones, routing escalations to appropriate internal stakeholders.
Maintain dashboards and tracking tools to ensure accurate, on-time reporting and smooth operational handoffs.
Counterpart Health develops Counterpart Assistant, an AI-enabled clinical tool that supports primary care physicians in diagnosing and managing chronic conditions. It is a subsidiary of Clover Health with a remote-first culture and a team focused on value-based care.
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.
Own Pivotal's legal work on provider billing and payer reimbursement disputes.
Negotiate directly with health plans and build arbitration award collection processes.
Partner with product and ops to turn legal judgment into scalable tools and systems.
Pivotal Health is a technology platform that helps healthcare providers get paid fairly in an increasingly complex reimbursement landscape. They are a collaborative, low-ego startup with offices in LA and NY, building AI-driven solutions for healthcare reimbursement.
Supports daily payment operations including chargeback and PayPal dispute workflows, issue investigation, and seller-facing resolution across multiple processors and regions.
Conducts technical operations analytics in five areas: authorization rates, chargeback rates, data normalization, processing costs, and reconciliation support.
Tracks payment costs by processor and region, monitors chargeback volumes and win rates, and performs data-quality checks to ensure consistency across systems.
FastSpring helps AI, SaaS, gaming, software, and digital product companies sell online globally by handling payment needs from checkout to taxes. Founded in 2005, it is a privately owned company headquartered in Santa Barbara with offices in multiple international locations and a network of over 2,500 sellers.
Work with insurance companies on behalf of patients to obtain payments for Banner Imaging teams
Research and hold payers accountable to pay expected rates according to contracts within allowed timeframes
Expand knowledge in appeals, follow up on denials, send medical records, verify eligibility and authorization, and negotiate with insurers
Banner Health is one of the largest nonprofit health care systems in the country, providing hospital services and care across multiple states. The organization is nationally recognized, earned Great Place To Work Certification, and offers diverse career opportunities with a strong focus on workplace excellence.
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.
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.
Coordinates patient, client, and insurance billings for a medical facility, ensuring accurate and complete financial records.
Processes insurance payments, obtains prior authorizations, and investigates denials to maximize reimbursement.
Communicates with providers and patients to resolve billing inquiries and maintain compliant billing operations.
HNL Lab Medicine is a medical laboratory providing testing and related services to physician offices, hospitals, long-term care facilities, employers, and industrial accounts. With more than 2,000 professionals, including board-certified pathologists and certified laboratory scientists, the company emphasizes patient-focused care and operational excellence.
Manage eligibility and accumulator file exchange operations, including SFTP connections, automated workflows, and partner relationships.
Troubleshoot claims and accumulator discrepancies by reconciling member-level data against TPA ledgers and adjudication platforms.
Lead data operations projects, including AI-assisted tool development, with proactive communication and impact analysis.
AffirmedRx is a pharmacy benefit management company on a mission to improve health care outcomes by bringing clarity, integrity, and trust to the industry. They are committed to transparency, clinical approaches, and state-of-the-art technology, fostering a culture where people thrive and values like trust, accountability, and innovation are central.
Process enrollment and billing tasks through multiple channels while managing an assigned caseload.
Develop a comprehensive understanding of Oscar's enrollment and billing processes, tools, and regulations.
Monitor work-in-progress, escalate issues, and support process improvement initiatives.
Oscar is a health insurance company built around a full-stack technology platform and a relentless focus on serving its members. Founded in 2012, Oscar behaves like a doctor in the family, and fosters a culture where people can be their most authentic selves.