Healthcare Operations Specialist

Our client is an AI and digital engineering company building intelligent solutions for some of healthcare's most complex operational challenges. They work at the intersection of cutting-edge technology and real-world healthcare workflows — and they are looking for a Healthcare Operations Specialist who knows that world from the inside.

What You'll Do

• Manage and improve day-to-day healthcare operations across areas like claims review, payment integrity, or billing compliance
• Apply your knowledge of CMS and state-specific regulations to keep processes accurate, efficient, and audit-ready
• Work within networks of arbitrators, clinicians, or external reviewers to coordinate case management and ensure quality outcomes
• Partner with our engineering team to translate operational pain points into tools that automate documentation, flag risks, and streamline case workflows
• Identify opportunities to reduce errors, accelerate resolutions, and scale processes in a fast-moving compliance environment
• Liaise with payers, providers, regulators, or legal teams as needed to align operations with broader standards

What You Bring

• 5+ years of experience in healthcare operations, with a focus on claims review, payment integrity, or billing compliance
• Strong working knowledge of CMS guidelines, state-specific healthcare regulations, and payer-provider dynamics
• Experience designing or improving workflows in compliance-heavy environments
• Comfort working alongside engineers and product teams — you can describe an operational problem in a way a tech team can act on
• Familiarity with tools that support case management, risk flagging, or documentation automation
• Strong analytical and communication skills; able to present clearly to both operational and technical audiences

Bonus Points

• Experience working with networks of arbitrators, clinicians, or external reviewers
• Background in claims adjudication, audit protocols, or billing dispute frameworks
• Prior experience in a tech or AI-driven healthcare environment