Clinical Operations Specialist

Claim Health; New York (NY); On-site; USD 60,000 - 85,000; Full time

Benefits offered by this job

Equity

Autonomy

Learning opportunities

Job summary

Claim Health is hiring a Clinical Operations Specialist to ensure the platform’s revenue cycle decisions are accurate across referrals, eligibility, prior authorizations, notices, denials, and billing.

You will work on edge cases, assess automation gaps, and collaborate with product and engineering to improve automation. Recent graduates are welcome, and healthcare experience is a plus but not required.

Qualifications

• 0–2 years of experience; recent graduates encouraged to apply
• Ability to judge unfamiliar cases and 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 payer portals
• Ability to thrive in fast-paced, ambiguous environments
• High ownership mentality and bias toward action

Responsibilities

• Own the Exception Queue: resolve edge cases against payer, state, and agency requirements
• Audit Quality and Accuracy: review automation outputs before they reach payer or agency
• Denials, Appeals, and Revenue Recovery: investigate denied/underpaid claims to resolution
• Turn Edge Cases Into Automation: configure rules and document findings for engineering
• Cross-Functional Execution: partner with product and engineering to refine intake, eligibility, and billing logic

Skills

Attention to detail

Decision making

Written communication

Fast learner

Ownership mindset

Education

Healthcare-related degree

Tools

SQL

Excel/Sheets

EMR systems

Job description

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.

About the Role

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.

What You’ll Do

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

What We’re Looking For

• 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

Optional Nice to Haves

• 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

Why Join Claim Health

• 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.