Healthcare Founder, Claims Intelligence

Forum Ventures

1d

About The Position

CMS just turned on the data. No one's using it yet.
TPAs have been auditing claims after costs lock in. CMS price transparency mandates changed that. Machine-readable pricing files now exist. You can see costs before adjudication and intervene in real-time.
Influence 5-10% of claims pre-adjudication, drive millions in value.
Why now: CMS Prior Authorization rule (Jan 2026), FHIR APIs mandated, price transparency files live. Infrastructure just went online.
The play: Start with pre-adjudication intelligence. Expand to post-claim repricing, denials, appeals. Build toward an AI-native TPA that charges on outcomes, not percentage of claims.
We're looking for Founders with deep experience in claims adjudication, TPA operations, or healthcare pricing. You know how TPAs make money, what drives their costs, and where intervention creates value. You also understand the technical layer - what's in machine-readable files, how FHIR APIs work, how claims flow through adjudication.
Your Partners in Co-Creation:
Forum's AI Studio brings together ambitious people, brilliant ideas, and capital to build the best B2B SaaS businesses in the world, from 0 to 1. In addition to capital and an idea, we provide founders with access to investor networks, fundraising support, and the resources needed to build transformational companies. We've launched 17 companies since 2023, and we're launching 7 more in 2026. We're designed to help Founders move faster, develop better insights, and build companies that have a higher success rate than startups built in any other way.

Forum derisks and accelerates the Founder path by:
A $250K USD investment, and an end-to-end fundraising playbook and network to raise your seed and Series A
A validation partner with proven playbooks, networks, and the systems to validate, unlock your ICP, ignite your sales pipeline, and beyond
The support of our experienced operating team - from business design, product development, growth, recruitment, legal and more
Executing a winning GTM strategy to get to $50-100K ARR, and the right MVP to ensure early traction
A community full of mentors, peers, and leaders
$100K worth of business perks
About you:
Domain expertise, plus you've been through the messy middle as a founder or early operator
You can attract, hire, and lead strong teams
You believe technology can change the world
You want to be a venture-backed founder
Canada or US-based, able to work in North American time zones
Please note, this is not an employment opportunity with Forum Ventures. If you are currently fundraising your pre-seed or Seed round, please pitch our investment team instead here.

Requirements

• Deep experience in claims adjudication, TPA operations, or healthcare pricing.
• Know how TPAs make money, what drives their costs, and where intervention creates value.
• Understand the technical layer - what's in machine-readable files, how FHIR APIs work, how claims flow through adjudication.
• Domain expertise, plus you've been through the messy middle as a founder or early operator
• You can attract, hire, and lead strong teams
• You believe technology can change the world
• You want to be a venture-backed founder
• Canada or US-based, able to work in North American time zones

Benefits

• A $250K USD investment, and an end-to-end fundraising playbook and network to raise your seed and Series A
• A validation partner with proven playbooks, networks, and the systems to validate, unlock your ICP, ignite your sales pipeline, and beyond
• The support of our experienced operating team - from business design, product development, growth, recruitment, legal and more
• Executing a winning GTM strategy to get to $50-100K ARR, and the right MVP to ensure early traction
• A community full of mentors, peers, and leaders
• $100K worth of business perks

What This Job Offers

• Education Level: No Education Listed
• Number of Employees: 101-250 employees