Backend Claims Management Specialist

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Backend Claims Management Specialist based in the United States.

This is a remote opportunity focused on improving healthcare revenue cycle performance through expert claims management and data-driven operational insights. You will investigate complex claims and denials, identify payment barriers, and uncover the root causes behind reimbursement challenges. The role combines hands-on claims expertise with analytical problem-solving, process improvement, and cross-functional collaboration. You will partner with Service Managers, BPO teams, Revenue Cycle, Operations, and Client Services to improve financial and operational outcomes. Your recommendations will help reduce denials and aged receivables, increase clean claim rates, and strengthen overall client performance. You will also share knowledge, develop standardized processes, and support teams in applying effective claims and denial-prevention practices. This role is well suited to a healthcare revenue cycle professional who combines strong payer knowledge with analytical thinking and a proactive approach to continuous improvement.

Accountabilities: Investigate and resolve complex healthcare claims, denials, reimbursement issues, and other barriers to timely payment.

Analyze denial trends and perform root cause analysis to identify recurring issues and opportunities to improve claim outcomes.

Support efforts to reduce aged accounts receivable and optimize reimbursement performance.

Escalate complex payer, claims, or operational issues to the appropriate internal stakeholders when necessary.

Develop and maintain strong knowledge of payer policies, reimbursement methodologies, claims processes, and client workflows.

Monitor payer trends and emerging risks to identify opportunities for process improvement and stronger financial performance.

Partner with internal teams to implement operational solutions that improve claims efficiency, quality, and reimbursement outcomes.

Collaborate with Service Managers to assess client health and identify opportunities to improve revenue cycle performance.

Present claims findings, performance trends, root causes, and recommendations to relevant internal stakeholders.

Support customer retention by proactively resolving operational issues and contributing to measurable improvements in client outcomes.

Provide guidance, education, and training to BPO teams on claims processing, denial management, and prevention best practices.

Develop and promote standardized processes that improve quality, consistency, and scalability.

Collaborate across Revenue Cycle, Operations, and Client Services to drive continuous improvement initiatives.

Track performance against key outcomes, including denial reduction, aged receivables, clean claim rates, and overall revenue cycle health.

Requirements

Professional experience in Revenue Cycle Management (RCM), medical billing, healthcare claims management, or a closely related field.

Strong knowledge of healthcare claims processing, denial management, payer reimbursement methodologies, and revenue cycle operations.

Ability to investigate complex claims issues, identify root causes, recognize trends, and develop practical recommendations.

Strong analytical skills and demonstrated proficiency in data analysis and performance reporting.

Excellent written and verbal communication skills, with the ability to present findings and influence cross-functional stakeholders.

Ability to collaborate effectively with operational teams, service leaders, BPO partners, and other internal stakeholders.

Experience with healthcare revenue cycle operations, denial prevention, appeals, or payer relations is preferred.

Experience driving operational improvements, process optimization, or standardized workflow initiatives is a plus.

Strong organizational skills and attention to detail when managing claims, performance data, and competing priorities.

Proactive, solution-oriented approach with a focus on measurable improvements and customer outcomes.

Ability to work independently in a fully remote environment while collaborating effectively across geographically distributed teams.

Must be eligible to work in the United States without employer sponsorship.

Willingness to travel occasionally to company headquarters in Denver, Colorado, or other U.S. locations as business needs require.

Benefits

Target base compensation of $16–$22 USD per hour in most U.S. locations, with final compensation based on location, market conditions, experience, and expertise.

Flexible work arrangements, including fully remote, hybrid, or in-office options within the United States.

Professional development and continued investment in employee growth.

Comprehensive health and wellness benefits available from day one.

Annual wellness stipend.

401(k) plan with up to a 4% company match and immediate vesting.

Flexible and generous flexible time off (FTO).

Employee Stock Purchase Program.

Opportunity to work with distributed teams across multiple regions.

Exposure to healthcare revenue cycle operations, claims analytics, payer strategy, and process optimization.

Opportunities to contribute directly to improvements in financial performance, operational efficiency, and customer outcomes.

Occasional travel opportunities for team collaboration and business needs.

How Jobgether works: We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team. We appreciate your interest and wish you the best!  Why Apply Through Jobgether?    Data Privacy Notice: By submitting your application, you acknowledge that Jobgether will process your personal data to evaluate your candidacy and share relevant information with the hiring employer. This processing is based on legitimate interest and pre-contractual measures under applicable data protection laws (including GDPR). You may exercise your rights (access, rectification, erasure, objection) at any time.     #LI-CL1