Senior Claims Reviewer

Arlo • New York City, NY

3d • $75,000 - $90,000

About The Position

Arlo is hiring for an experienced Claims Reviewer to join our stop-loss and medical claims operations team. This role is responsible for reviewing aggregate claims as well as high-cost and complex claims, ensuring accurate adjudication, and identifying opportunities for cost containment and fraud prevention. You will play a critical part in protecting Arlo’s clients and ensuring every claim is processed accurately, efficiently, and in line with plan provisions.

Requirements

• 5+ years of experience in medical or stop-loss claims review, audit, or adjudication
• Meticulous, analytical, and detail-oriented — you take pride in accuracy and root-cause thinking
• Experienced in identifying inappropriate billing, duplicate charges, and coding errors (ICD-10, CPT, HCPCS, DRG)
• Comfortable communicating with TPAs, providers, and internal stakeholders to resolve discrepancies
• In-depth understanding of plan design, coordination of benefits, subrogation, and provider billing practices
• Familiarity with fraud, waste, and abuse (FWA) detection
• Strong working knowledge of claims processing systems and supporting tools (Excel, SQL, Python)
• Bachelor’s degree or equivalent experience in healthcare administration, insurance, or a related field.

Responsibilities

• Review stop-loss and large medical claims for accuracy, completeness, and compliance with plan terms.
• Adjust and re-adjudicate claims where errors, inappropriate billing, or overpayments are identified.
• Investigate potentially fraudulent or wasteful claims by analyzing billing patterns, provider behavior, and coding anomalies.
• Collaborate with cost containment partners, networks, and TPAs to validate billed charges and recover overpayments.
• Use data and reporting tools to spot trends, anomalies, and emerging risk areas in claims submissions.
• Provide detailed documentation and recommendations for denials, reimbursements, or escalations.
• Support process improvement initiatives and help refine Arlo’s claims review and cost containment protocols.

Benefits

• High ownership: You’ll get real responsibility from day one—our high-trust team empowers you to run with big problems and shape core parts of the company.
• Join an important mission: Your work directly influences how people access care and improves lives at scale.
• Growth & expansion: We’re moving fast, and as we grow, your scope will grow with us—new challenges, bigger opportunities, and rapid career velocity.
• Apply AI to a problem that matters: Instead of optimizing ads or cutting labor costs, you’ll use AI to fundamentally reimagine how people get healthcare.
• High pace, high collaboration: We operate with velocity, first-principles thinking, and a team that works closely, openly, and with ambition.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level