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Claim Health is an AI Revenue Platform for Post-Acute Care, serving home health, skilled nursing, home care, and hospice providers. The company automates revenue-cycle operations—referral intake, eligibility verification, prior authorization, denials and appeals, and billing—replacing fragmented manual workflows with intelligent software.
As a Clinical Operations Specialist, you will own the accuracy and execution of the platform's automation. You'll work a live exception queue handling edge cases across the full revenue cycle that the automation cannot resolve, ensuring compliance with payer, state, and agency requirements. You'll audit automation outputs for accuracy and consistency before they reach payers or agencies, catching errors upstream (wrong payer, missing authorizations, coverage gaps) rather than discovering them as denials.
You'll investigate denied and underpaid claims to determine root cause and work appeals to resolution, tracing denials back to their origin and closing upstream gaps. You'll tag every exception with a clear cause so recurring failures become visible and automatable. Using internal tooling, you'll configure rules, mappings, coverage logic, and thresholds to turn solved problems into permanent automation. You'll document findings and write escalations with enough detail for engineering to act on them.
You'll partner cross-functionally with product and engineering to refine intake, eligibility, authorization, and billing logic. You'll build fluency across payers, plan types, and EMRs as you work an increasingly wide range of cases, serving as the feedback loop between queue reality and product development.
This is a high-autonomy role with direct exposure to the engineering team. Thousands of referrals, authorizations, and claims move through the platform weekly; missed details mean delayed care or unpaid work. You'll sit alongside the team building the automation, and the edge cases you catch become the next version of the product.
REQUIREMENTS:
- 0–2 years of experience; recent graduates encouraged to apply
- Comfort making judgment calls on unfamiliar cases with no playbook, and instinct to document the playbook afterward
- Exceptional attention to detail; revenue cycle work is unforgiving of small errors
- Clear, concise written communication; you'll document causes and write escalations daily
- Fast at picking up new software; you'll learn multiple EMRs and payer portals
- Ability to thrive in fast-paced, ambiguous environments
- High ownership mentality and bias toward action
OPTIONAL NICE-TO-HAVES:
- Healthcare-related degree (nursing, health administration, public health, health information management)
- Clinical background or license (LPN, LVN, RN, MA, paramedic)
- Experience with healthcare operations, claims, billing, eligibility, denials and appeals, utilization management, or revenue cycle workflows
- Familiarity with EMRs (HCHB, KanTime, WellSky, Axxess)
- Comfort with data tools (SQL, Excel, Google Sheets, Airtable, Notion, internal dashboards)
- Habit of automating own work (scripts, spreadsheets)
