This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for an EverHealth - Backend Claims Management Specialist based in United States.
This role plays a key part in improving healthcare revenue cycle performance through expert claims management and data-driven problem solving.
You will investigate complex claims, denials, reimbursement issues, and aged receivables to identify barriers to timely payment.
Working closely with Service Managers, BPO teams, Revenue Cycle, Operations, and Client Services, you will turn claims insights into practical improvements.
The role combines hands-on operational expertise with analysis of payer trends, denial patterns, and root causes.
You will also help strengthen team capabilities through education, standardized processes, and best-practice guidance.
Your work will directly contribute to cleaner claims, stronger client outcomes, improved financial performance, and higher client retention.
This is an opportunity to make a measurable impact in a collaborative, distributed healthcare technology environment.
Accountabilities:
- Manage complex claims and reimbursement issues by investigating denials, identifying payment barriers, resolving discrepancies, and escalating complex payer or operational matters when necessary.
- Analyze revenue cycle performance by reviewing denial trends, aged accounts receivable, reimbursement patterns, and other operational data to identify root causes and opportunities for improvement.
- Improve claims outcomes by recommending and supporting actions that increase clean claim rates, reduce denials and aged receivables, and optimize reimbursement performance.
- Build payer and operational expertise by developing a strong understanding of payer policies, reimbursement methodologies, client workflows, emerging payer trends, and potential operational risks.
- Partner with Service Managers and operational teams to improve client health, address revenue cycle challenges, and implement solutions that strengthen financial and operational performance.
- Present insights and recommendations to internal stakeholders, clearly communicating performance trends, identified issues, and proposed corrective actions.
- Support customer success and retention through proactive identification and resolution of claims and revenue cycle problems.
- Educate and support BPO teams by providing guidance and training on claims processing, denial prevention, reimbursement practices, and quality standards.
- Develop standardized processes that improve consistency, quality, efficiency, and scalability across claims and revenue cycle operations.
- Collaborate cross-functionally with Revenue Cycle, Operations, Client Services, and other teams to drive continuous improvement and strengthen customer outcomes.
Requirements:
- Professional experience in healthcare revenue cycle management, medical billing, or healthcare claims management.
- Strong knowledge of claims processing and denial management, including payer reimbursement methodologies and common causes of payment delays or denials.
- Analytical and problem-solving mindset, with the ability to identify trends, conduct root cause analysis, interpret performance data, and translate findings into actionable recommendations.
- Experience with data analysis and performance reporting, including the ability to use operational metrics to assess revenue cycle performance.
- Strong written and verbal communication skills, with the ability to explain complex claims and reimbursement issues clearly and influence cross-functional stakeholders.
- Experience in healthcare revenue cycle operations, denial prevention, appeals, or payer relations is preferred.
- Experience driving operational improvements and process optimization is a plus.
- Collaborative and customer-focused approach, with the ability to work effectively with internal teams, service managers, and BPO partners.
- Strong attention to detail and organizational skills, particularly when managing complex claims and identifying patterns across large volumes of data.
- Ability to work independently in a distributed environment while remaining responsive, adaptable, and focused on measurable outcomes.
- Candidates must be authorized to work in the United States without sponsorship.
- Occasional travel to company headquarters or other U.S. office locations may be required.
Benefits:
- Base compensation: approximately $16–$22 USD per hour in most U.S. locations, with final offers determined by location, market conditions, experience, and expertise.
- Flexible work arrangements, with the option to work remotely, in-office, or in a hybrid setup within the United States.
- Health and wellness benefits available from Day 1, including an annual wellness stipend.
- 401(k) plan with up to a 4% employer match and immediate vesting.
- Flexible and generous FTO (Flexible Time Off).
- Employee Stock Purchase Program.
- Ongoing investment in professional development and career growth.
- Opportunity to work with distributed teams across multiple regions.
- Occasional travel opportunities to U.S. offices and headquarters as required.
How Jobgether works:
We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team.
We appreciate your interest and wish you the best!
Data Privacy Notice: By submitting your application, you acknowledge that Jobgether will process your personal data to evaluate your candidacy and share relevant information with the hiring employer. This processing is based on legitimate interest and pre-contractual measures under applicable data protection laws (including GDPR). You may exercise your rights (access, rectification, erasure, objection) at any time.
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