Claim Health
Operations Specialist
New York City. Posted a month ago
The role
The Operations Specialist owns the accuracy of platform decisions by managing an exception queue for the revenue cycle. This role involves resolving edge cases for intake, eligibility, authorization, and claims while providing feedback to the product and engineering teams.
What you will do
- Work a live queue containing edge cases for intake, eligibility, authorization, notices, and claims
- Meet turnaround expectations on time-sensitive work
- Review automation outputs for accuracy, consistency, and compliance
- Tag exceptions with a clear cause to make recurring failures visible
- Investigate denied and underpaid claims and work the appeal through to resolution
- Track denial patterns by payer and agency
- Configure rules, mappings, coverage logic, and thresholds in internal tooling
- Document findings and write escalations for engineering
- Partner with product and engineering to refine workflow logic
- Serve as the feedback loop between the queue and product development
Required qualifications
- 0–2 years of experience
- Comfort making a judgment call on an unfamiliar case with no playbook
- Exceptional attention to detail
- Clear, concise written communication
- Fast at picking up new software
- Ability to thrive in fast-paced, ambiguous environments
- High ownership mentality and bias toward action
Nice to have
- A healthcare-related degree — nursing, health administration, public health, health information management
- A clinical background or license: LPN, LVN, RN, MA, or paramedic
- Experience with healthcare operations, claims, billing, eligibility, denials and appeals, utilization management, or revenue cycle workflows
- Familiarity with EMRs like HCHB, KanTime, WellSky, or Axxess
- Comfort working with data and tools such as SQL, Excel/Google Sheets, Airtable, Notion, or internal dashboards
- A habit of automating your own work — scripts, spreadsheets, whatever you built to stop doing something twice
Benefits
- Meaningful equity
About the company
Claim Health is the AI Revenue Platform for Post-Acute Care. It uses an intelligent, software-driven platform to unify data and automate execution for post-acute providers.