Backend Claims Management Specialist

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for an EverHealth - Backend Claims Management Specialist based in United States.

• Manage complex claims and reimbursement issues by investigating denials, identifying payment barriers, resolving discrepancies, and escalating complex payer or operational matters when necessary.
• Analyze revenue cycle performance by reviewing denial trends, aged accounts receivable, reimbursement patterns, and other operational data to identify root causes and opportunities for improvement.
• Improve claims outcomes by recommending and supporting actions that increase clean claim rates, reduce denials and aged receivables, and optimize reimbursement performance.
• Build payer and operational expertise by developing a strong understanding of payer policies, reimbursement methodologies, client workflows, emerging payer trends, and potential operational risks.
• Partner with Service Managers and operational teams to improve client health, address revenue cycle challenges, and implement solutions that strengthen financial and operational performance.
• Present insights and recommendations to internal stakeholders, clearly communicating performance trends, identified issues, and proposed corrective actions.
• Support customer success and retention through proactive identification and resolution of claims and revenue cycle problems.
• Educate and support BPO teams by providing guidance and training on claims processing, denial prevention, reimbursement practices, and quality standards.
• Develop standardized processes that improve consistency, quality, efficiency, and scalability across claims and revenue cycle operations.
• Collaborate cross-functionally with Revenue Cycle, Operations, Client Services, and other teams to drive continuous improvement and strengthen customer outcomes.

• Professional experience in healthcare revenue cycle management, medical billing, or healthcare claims management.
• Strong knowledge of claims processing and denial management, including payer reimbursement methodologies and common causes of payment delays or denials.
• Analytical and problem-solving mindset, with the ability to identify trends, conduct root cause analysis, interpret performance data, and translate findings into actionable recommendations.
• Experience with data analysis and performance reporting, including the ability to use operational metrics to assess revenue cycle performance.
• Strong written and verbal communication skills, with the ability to explain complex claims and reimbursement issues clearly and influence cross-functional stakeholders.
• Experience in healthcare revenue cycle operations, denial prevention, appeals, or payer relations is preferred.
• Experience driving operational improvements and process optimization is a plus.
• Collaborative and customer-focused approach, with the ability to work effectively with internal teams, service managers, and BPO partners.
• Strong attention to detail and organizational skills, particularly when managing complex claims and identifying patterns across large volumes of data.
• Ability to work independently in a distributed environment while remaining responsive, adaptable, and focused on measurable outcomes.
• Candidates must be authorized to work in the United States without sponsorship.
• Occasional travel to company headquarters or other U.S. office locations may be required.

• Base compensation: approximately $16–$22 USD per hour in most U.S. locations, with final offers determined by location, market conditions, experience, and expertise.
• Flexible work arrangements, with the option to work remotely, in-office, or in a hybrid setup within the United States.
• Health and wellness benefits available from Day 1, including an annual wellness stipend.
• 401(k) plan with up to a 4% employer match and immediate vesting.
• Flexible and generous FTO (Flexible Time Off).
• Employee Stock Purchase Program.
• Ongoing investment in professional development and career growth.
• Opportunity to work with distributed teams across multiple regions.
• Occasional travel opportunities to U.S. offices and headquarters as required.