Clinical Operations Specialist

About Claim Health

Claim Health is the AI Revenue Platform for Post-Acute Care.

With the US population aging and preference for care moving to the home, post-acute care (home health, skilled nursing, home care, hospice) is one of the fastest growing verticals within healthcare. Post-acute providers operate across fragmented systems, manual workflows, and reactive processes that create operational drag and financial uncertainty. Claim Health replaces this fragmentation with an intelligent, software-driven platform that unifies data, automates execution, and enables real-time decision-making across revenue-critical operations.

We’re building an adaptive platform that brings clarity, predictability, and scale to environments where reliability matters.

We’re hiring a Clinical Operations Specialist to own the accuracy of what our platform decides. Our automation runs the revenue cycle end to end for the majority of cases — referral intake, eligibility and benefits verification, prior authorization, notices of election, denials and appeals, and billing. You own the cases it can’t, and you make sure the cases it can are right.

This is a high-autonomy role spanning the full revenue cycle, not a single workflow. Thousands of referrals, authorizations, eligibility checks, and claims move through the platform every week, and a missed detail means a delayed start of care or unpaid work. You’ll sit directly alongside the team building the automation — the edge cases you catch and the patterns you surface become the next version of the product.

This role is open to recent graduates. Healthcare experience is a plus, not a requirement.

• Work a live queue containing edge cases for intake, eligibility, authorization, notices, and claims — resolving each case against payer, state, and agency requirements when no automation covers them

• Meet turnaround expectations on time-sensitive work where a few minutes delay means delayed care or a missed filing window

• Review automation outputs for accuracy, consistency, and compliance before they reach the agency or the payer

• Catch errors upstream — a wrong payer, a missing face-to-face, a misread document, a coverage gap — rather than discovering them as denials

• Tag every exception with a clear cause so recurring failures become visible instead of absorbed

• Investigate denied and underpaid claims, determine root cause, and work the appeal through to resolution

• Trace denials back to their origin — an eligibility miss at intake, a missing authorization, a coding or documentation gap — and close the upstream hole

• Track denial patterns by payer and agency and flag the ones worth automating against

• Configure rules, mappings, coverage logic, and thresholds in internal tooling so solved problems stay solved

• Document findings and write escalations with enough detail that engineering can act on them

• Track patterns across payers, states, and EMRs and bring them to the team as automation candidates

• Partner with product and engineering to refine the logic powering intake, eligibility, authorization, and billing workflows

• Build fluency across payers, plan types, and EMRs as you work an increasingly wide range of cases

• Serve as the feedback loop between what actually happens in the queue and what gets built next

• 0–2 years of experience; recent graduates encouraged to apply

• Comfort making a judgment call on an unfamiliar case with no playbook — and the instinct to write the playbook afterward

• Exceptional attention to detail. Revenue cycle work is unforgiving of small errors

• Clear, concise written…