Claims Operations Specialist

Job Description

Job Description

We are seeking a detail-oriented Claims Operations Specialist to own the end-to-end billing process for both medical and pharmacy claims. This role oversees claim submission, tracking, reconciliation and serves as a key point of contact for internal teams and clients. The ideal candidate is a quick learner with strong analytical skills and a desire to grow in a fast-paced, non-traditional healthcare environment. Experience with digital health, S-codes or pharmacy claims is a plus.

Responsibilities :

• Oversee the full revenue cycle process for both medical and pharmacy claims, including submission, QA, payment posting and AR follow-up.
• Review, investigate and resolve claim denials and rejections to ensure timely and accurate reimbursement.
• Assist with client onboarding, including claims setup, payer integration, Candid configuration and rules engine alignment.
• Perform monthly billing operations such as claims reconciliation, bank reconciliation and revenue validation.
• Serve as a point of contact for clients, participating in onboarding calls, monthly check-ins and responding to billing questions.
• Collaborate with Sales, Product, Data and Client Success teams on RFPs, internal process updates and issue resolution.

Qualifications :