Clinical Operations Specialist at Claim Health in New York City

Job description

• Application
• 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.

Responsibilities

• Own the Exception Queue
• 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
• Audit Quality and Accuracy
• 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
• Denials, Appeals, and Revenue Recovery
• 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
• Turn Edge Cases Into Automation
• 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
• Cross-Functional Execution
• 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

Requirements

• 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 communication; you'll document causes and write escalations daily
• Fast at picking up new software. You'll learn several EMRs and a long list of payer portals
• Ability to thrive in fast-paced, ambiguous environments
• High ownership mentality and bias toward action
• A healthcare-related degree — nursing, health administration, public health, health information management
• A clinical background or license: LPN, LVN, RN, MA, or paramedic. If you've worked a floor and want out of shift work without leaving healthcare, this is a real path
• 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

Skills

Required

• Exceptional attention to detail
• Clear, concise written communication
• Fast at picking up new software

Benefits

• Real impact: Your work affects mission-critical operations and financial outcomes
• Ownership: Meaningful equity and influence over the platform's direction
• Hard problems: Complex systems, real constraints, no toy use cases
• Speed: Small team, fast feedback loops, high leverage work. We have a bias towards moving as fast as possible.
• Culture: Low ego, high standards, deep respect for craft
• Fun: One of the most important things we screen for is can you laugh with us.