Remote Healthcare Policy Analyst - AI-Driven Claims

Jobgether; Oregon; Hybrid; USD 107,000 - 130,000; Full time

Benefits offered by this job

Remote-first work culture

Equity opportunities

401(k) with company match

Flexible PTO

Professional development

Job summary

Jobgether is seeking a Business Analyst, Clinical & Reimbursement Policy in the United States. You will oversee regulatory-aligned clinical and reimbursement policies, leveraging AI tools to automate monitoring and research across CMS regulations and NCDs/LCDs.

Collaborate with Clinical, Claims, Compliance, and Data Science teams to translate guidance into technical rules. The role focuses on policy lifecycle, accuracy, and continuous improvement of claims operations, with a remote-first,

Qualifications

• 5+ years in healthcare claims, configuration, or reimbursement policy.
• Strong Medicare Advantage knowledge and regulatory interpretation skills.
• Experience managing external vendors and ensuring quality standards.
• Interest in AI technologies to improve research, monitoring, and workflows.
• Ability to translate regulatory and business requirements into actionable specs.

Responsibilities

• Oversee full lifecycle of clinical and reimbursement policies with CMS alignment.
• Lead AI-driven policy monitoring and regulatory research initiatives.
• Collaborate with Clinical, Claims, Compliance, Configuration, and Data Science teams.
• Translate regulatory guidance into functional specifications for systems.
• Manage external vendor performance and partnerships.

Skills

Healthcare claims

Medicare Advantage

Analytics

Vendor management

AI technologies

LLMs (ChatGPT, Claude, Gemini)

Regulatory research

Policy lifecycle management

Regulatory interpretation

Cross-functional collaboration

Education

Coding certifications (CPC/CCS/COC/CIC)

Job description

Jobgether is seeking a Business Analyst, Clinical & Reimbursement Policy in the United States. You will oversee regulatory-aligned clinical and reimbursement policies, leveraging AI tools to automate monitoring and research across CMS regulations and NCDs/LCDs.

Collaborate with Clinical, Claims, Compliance, and Data Science teams to translate guidance into technical rules. The role focuses on policy lifecycle, accuracy, and continuous improvement of claims operations, with a remote-first,