Backend Claims Management Specialist

Quick Facts

• Role: Backend Claims Management Specialist

• Work setup: Remote in the US (occasional travel possible)

• Focus: Backend revenue cycle performance and claim denial outcomes

Description

The Backend Claims Management Specialist enables timely claim resolution by providing operational expertise, strategic guidance, and educational support focused on backend revenue cycle performance. You will partner with Service Managers and BPO teams to investigate complex claims and denials, analyze denial trends, and drive data-driven recommendations that improve claim outcomes and overall client health.

Responsibilities

• Investigate and resolve complex claims, denials, and reimbursement issues

• Analyze denial trends and identify root causes to improve claim outcomes

• Support reduction of aged accounts receivable and optimize reimbursement performance

• Escalate complex payer or operational issues as needed

• Develop expertise in payer policies, reimbursement methodologies, and client workflows

• Identify payer trends and emerging risks to support process improvement

• Partner with internal teams to implement solutions that improve operational efficiency and financial performance

• Present findings, recommendations, and performance trends to internal stakeholders

• Provide guidance and training to BPO teams on claims processing and denial prevention best practices

• Develop and promote standardized processes to improve quality and consistency

• Collaborate cross-functionally to drive continuous improvement

Requirements

• Experience in revenue cycle management (RCM), medical billing, or healthcare claims management

• Strong knowledge of claims processing, denial management, and payer reimbursement methodologies

• Analytical mindset for trend identification and root-cause analysis

• Strong written and verbal communication skills to influence cross-functional teams

• Proficiency in data analysis and performance reporting

• Eligibility: Must be eligible to work in the US without sponsorship

Benefits

• Flexibility to work in-office, remote, or hybrid within your country of employment

• Investment in professional development

• Day 1 health and wellness benefits with an annual wellness stipend

• 401(k) with up to a 4% match and immediate vesting

• Flexible and generous FTO (time off)

• Employee Stock Purchase Program

• Target compensation: $18–$22 USD per hour in most US locations (final offer varies by location and experience)