Claims Operations Specialist

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October 24

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Vida Health

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Healthcare Insurance • Wellness • SaaS

Vida Health is a company committed to improving health outcomes for various physical and mental health conditions, including diabetes, obesity, depression, and hypertension. They offer personalized, human-led care combined with digital technology to manage and treat these complex conditions. Vida Health partners with employers, health plans, and consultants to provide comprehensive health solutions. Their services include video chats and text-based messaging with healthcare providers, and they utilize machine learning and synced devices to personalize member care. They focus on significant cost savings and improved health outcomes for cardiometabolic conditions, guaranteeing results and offering up to 100% of fees at risk for both physical and mental healthcare.

501 - 1000 employees

Founded 2014

⚕️ Healthcare Insurance

🧘 Wellness

☁️ SaaS

📋 Description

• Oversee the full revenue cycle process for both medical and pharmacy claims, including submission, QA, payment posting and AR follow-up. • Review, investigate and resolve claim denials and rejections to ensure timely and accurate reimbursement. • Assist with client onboarding, including claims setup, payer integration, Candid configuration and rules engine alignment. • Perform monthly billing operations such as claims reconciliation, bank reconciliation and revenue validation. • Serve as a point of contact for clients, participating in onboarding calls, monthly check-ins and responding to billing questions. • Collaborate with Sales, Product, Data and Client Success teams on RFPs, internal process updates and issue resolution.

🎯 Requirements

• Bachelor’s degree in Healthcare Administration, Business or a related field, or equivalent practical experience. • CPB, CRCS or CMRS strongly preferred. • 4+ years of experience in revenue cycle management, medical billing or claims operations. • Experience in the digital health space is a plus. • Prior experience using Candid or similar RCM platforms is preferred. • Advanced Excel skills (e.g., pivot tables,VLOOKUP, formulas). • Familiarity with BigQuery, Looker, NetSuite and Candid. • Understanding of general healthcare reimbursement principles. • Familiarity with pharmacy claims and/or alternative coding (eg., S-codes) preferred. • Self-starter with a proactive approach to problem-solving. • Strong analytical mindset with the ability to work through ambiguity. • Comfortable working independently with minimal direction. • Strong attention to detail and accountability for high-quality work. • Effective communicator with experience engaging clients directly.