Operations Specialist

About Claim HealthClaim 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.About the RoleWe're hiring an 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.What You'll DoOwn the Exception QueueWork 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 themMeet turnaround expectations on time-sensitive work where a few minutes delay means delayed care or a missed filing windowAudit Quality and AccuracyReview automation outputs for accuracy, consistency, and compliance before they reach the agency or the payerCatch errors upstream — a wrong payer, a missing face-to-face, a misread document, a coverage gap — rather than discovering them as denialsTag every exception with a clear cause so recurring failures become visible instead of absorbedDenials, Appeals, and Revenue RecoveryInvestigate denied and underpaid claims, determine root cause, and work the appeal through to resolutionTrace denials back to their origin — an eligibility miss at intake, a missing authorization, a coding or documentation gap — and close the upstream holeTrack denial patterns by payer and agency and flag the ones worth automating againstTurn Edge Cases Into AutomationConfigure rules, mappings, coverage logic, and thresholds in internal tooling so solved problems stay solvedDocument findings and write escalations with enough detail that engineering can act on themTrack patterns across payers, states, and EMRs and bring them to the team as automation candidatesCross-Functional ExecutionPartner with product and engineering to refine the logic powering intake, eligibility, authorization, and billing workflowsBuild fluency across payers, plan types, and EMRs as you work an increasingly wide range of casesServe as the feedback loop between what actually happens in the queue and what gets built nextWhat We're Looking For0–2 years of experience; recent graduates encouraged to applyComfort making a judgment call on an unfamiliar case with no playbook — and the instinct to write the playbook afterwardExceptional attention to detail. Revenue cycle work is unforgiving of small errorsClear, concise written communication; you'll document causes and write escalations dailyFast at picking up new software. You'll learn several EMRs and a long list of payer portalsAbility to thrive in fast-paced, ambiguous environmentsHigh ownership mentality and bias toward actionOptional Nice to HavesA healthcare-related degree — nursing, health administration, public health, health information managementA 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 pathExperience with healthcare operations, claims, billing, eligibility, denials and appeals, utilization management, or revenue cycle workflowsFamiliarity with EMRs like HCHB, KanTime, WellSky, or AxxessComfort working with data and tools such as SQL, Excel/Google Sheets, Airtable, Notion, or internal dashboardsA habit of automating your own work — scripts, spreadsheets, whatever you built to stop doing something twiceWhy Join Claim HealthReal impact: Your work affects mission-critical operations and financial outcomesOwnership: Meaningful equity and influence over the platform's directionHard problems: Complex systems, real constraints, no toy use casesSpeed: Small team, fast feedback loops, high leverage work. We have a bias towards moving as fast as possible.Culture: Low ego, high standards, deep respect for craftFun: One of the most important things we screen for is can you laugh with us.