A claims operations platform that validates payer-specific billing workflows before rollout and monitors submissions, remittances, denials, and follow-ups in one place.
Added Jun 8, 2026
Last signal 1w ago
Healthcare companies rolling out claims-based billing across payers must coordinate claim generation, submission, remittance processing, denials, appeals, and payer follow-up. Small configuration errors or payer-specific requirements can create downstream denials, delayed reimbursement, and operational readiness gaps during pilots and launches.
The product connects to billing, EHR, and revenue-cycle data sources to model each payer’s claims lifecycle requirements and flag configuration risks before launch. It provides workflow tracking for claim status, remittance, denials, appeals, and payer follow-up, with dashboards for pilot readiness and rollout timelines.
Job postings show multiple healthcare companies hiring around payer integrations, claims lifecycle operations, denials prevention, and AI-enabled payer workflows. Claims-based care management fees and risk-based payment models are increasing the need for more automated operational control.
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Own the Claims & Payments product surface: claims adjudication logic, payer and employer reconciliation, payment operations tooling, and provider payments Instrument and monitor claims and payments data — identify where errors occur, where reconciliation breaks down, and surface findings to the team
🔗 Connect the medical, operational, regulatory, and financial picture. Help teams understand how claim decisions affect medical spend, indemnity, reserves, return-to-work outcomes, litigation exposure, and loss performance. 🛠 Improve the inputs and outputs of the claims process. Shape how claim information is captured and structured, then improve the workflows, reporting, automation, and product experiences built from it.
Design and scale AI-native workflows: Across claims management, denial resolution, QA, reconciliation, payment posting, and payer operations. Build real-time RCM reporting: Build and ship dashboards, reporting infrastructure, and operational visibility across the revenue cycle for the rest of our team.
Payer Strategy & Playbook Development: Develop comprehensive, repeatable playbooks for AI transformation across the payer value chain. Create frameworks that address claims adjudication, prior authorization, care management, member services, provider contracting, Medicare Advantage operations, and risk adjustment.
You have knowledge of EHRs - ideally in a Primary Care setting, medical billing, reimbursement models, Medicare Advantage, and risk-based payment arrangements.
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