Junior Clinical Content Specialist

Saarthi; Bengaluru; On-site; INR 1,000,000 - 2,000,000; Full time

Job summary

CoverSelf in Bengaluru is seeking a Clinical Content Specialist to translate clinical guidelines and payer policies into rules and algorithms for automated claims validation.

You will develop and maintain payment integrity rules, build code edit solutions, and conduct research on medical policies and reimbursement methodologies to ensure accurate payments and compliant adjudication.

Qualifications

• Translate clinical guidelines into business rules for automated claims validation.
• Develop and maintain payment integrity rules and edits.
• Research medical policies and reimbursement methodologies to inform rules.

Responsibilities

• Develop and maintain payment integrity rules, edits, and policies
• Translate Healthcare Payer guidelines → business rules
• Build code edit solutions to detect incorrect payments
• Conduct research on medical policies and reimbursement methodologies

Skills

Clinical content

Policy translation

Rule frameworks

Algorithm design

Job description

About CoverSelf

CoverSelf empowers US healthcare payers with a truly next-generation, cloud-native, holistic, and customizable platform designed to prevent and adapt to the ever-evolving inaccuracies in healthcare claims and payments. By reducing complexity and administrative costs, we offer a unified, healthcare-dedicated platform backed by top VCs like BeeNext, 3One4 Capital, and Z21 Ventures.

Position Overview

This role focuses on developing clinical content, payment integrity rules, and code edit solutions. The Clinical Content Specialist will translate clinical guidelines and payer policies into business logic, algorithms, and rule frameworks for automated claims validation.

Key Responsibilities

• Develop and maintain payment integrity rules, edits, and policies
• Translate Healthcare Payer guidelines → business rules
• Build code edit solutions to detect incorrect payments
• Conduct research on medical policies and reimbursement methodologies