Payer policy specialist

Hiring: Payer Policy Specialist – Healthcare AI Evaluation Project

We are looking for an experienced Payer Policy Specialist to support a short-term Healthcare AI Evaluation Project.

Role: Payer Policy Specialist

Experience: 3+ years

Work Mode: Remote

Key Responsibilities

• Review and evaluate healthcare payer policies, coverage criteria, and medical guidelines.
• Analyze payer policies to determine coverage, eligibility, and medical necessity requirements.
• Validate policy information against relevant source documents and guidelines.
• Identify discrepancies, gaps, or inconsistencies in policy interpretation.
• Review and assess clinical and administrative criteria used in payer decision-making.
• Provide accurate documentation and feedback to support the evaluation process.

Requirements

• 3+ years of experience in payer policy, health insurance, utilization management, medical review, or a related healthcare field.
• Strong understanding of health insurance policies, coverage criteria, and medical necessity guidelines.
• Experience reviewing and interpreting payer policies and clinical documentation.
• Strong analytical and research skills with excellent attention to detail.
• Ability to work with structured documentation and evaluate information against defined criteria.
• Experience with healthcare QA, medical policy review, or healthcare AI evaluation will be an advantage.

Interested

Please share your updated resume via LinkedIn message, along with a brief summary of your relevant payer policy/healthcare experience.

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