Clinical Operations Specialist

Claim Health•New York City, NY

18d

About The Position

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. 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.

Requirements

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

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

Responsibilities

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