Junior Payment Integrity Analyst

Coverself Inc.; Bengaluru; On-site; INR 600,000 - 900,000; Full time

Benefits offered by this job

Best-in-class compensation

Health insurance for Family

Personal Accident Insurance

Flexible Leave Policy

Certification and Course Reimbursement

Medical Coding CEUs

Job summary

CoverSelf in Bengaluru seeks a Clinical Content Specialist to translate payer guidelines into robust business logic and develop code edit solutions that detect incorrect payments. The role centers on creating clinical content, payment integrity rules, and rule frameworks for automated claims validation.

Location is Jayanagar, Bangalore; work from office. Freshers with pharmacy/clinical training and a research mindset are welcome to apply and grow within a supportive, diverse team.

Qualifications

• Freshers with a strong foundation in Pharmacy/Clinical concepts and a research mindset can be considered.
• Ability to convert clinical guidelines into logical rules and automated rules.
• Excellent communication, articulation, and interpretation skills.

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

Analytical thinking

Interpretation skills

Verbal communication

Written communication

Willingness to learn

Education

MBBS/BDS/BPT/BAMS

Nursing: BSc/MSc

Pharmacist degree (B.Pharm/M.Pharm/PharmD)

Life Science degree

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.

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

Requirements

• Passionate about working in the clinical domain, with a focus on learning and growth
• Strong foundation in clinical concepts, Ability to convert clinical guidelines into logical rules
• Demonstrated experience in research work, college thesis, or complex case study analysis
• Strong research mindset with the ability to interpret clinical and medical literature
• Excellent communication, articulation, and interpretation skills
• Ability to translate complex clinical information into clear and structured insights
• Sound clinical knowledge with attention to detail and accuracy
• Support the configuration of payment integrity rules/solutions based on business requirements.
• Assist with testing configured rules and validating results to ensure expected outcomes.

Qualifications

Education & Certification (one of the following required):

• Medical Degree (e.g., MBBS, BDS, BPT, BAMS etc)
• Nursing: Bachelor/Master of Science in Nursing
• Pharmacist Degree (B.Pharm, M.Pharm or PharmD)
• Life Science -Bachelor/Master

Certification Requirements

• Must hold any of the following certifications: CPC, CPMA, COC, CIC, CPC-P, CCS or any specialty certifications from AHIMA or AAPC.

Experience

Freshers with a strong foundation in Pharmacy/Clinical concepts and a research mindset can be considered.

Key Skills

• Strong analytical & interpretation skills
• Excellent verbal & written communication skills.
• Excellent Interpretation and articulation skills
• Strong analytical, critical thinking, and problem-solving skills
• Willingness to learn new products and tools

Work Details

• Location: Jayanagar, Bangalore
• Mode: Work from Office

Benefits

• Best-in-class compensation
• Health insurance for Family
• Personal Accident Insurance
• Friendly and Flexible Leave Policy
• Certification and Course Reimbursement
• Medical Coding CEUs and Membership Renewals
• Health checkup
• And many more!

Our Commitment To Diversity

At CoverSelf, we are building a global workplace where every individual can discover their true potential, passion, and purpose — regardless of background, gender, race, sexual orientation, religion, or ethnicity. We believe a diverse workplace fosters innovation, creativity, and progress for our employees, communities, and business.