Claim Association QA Specialist – Part-Time

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The Public Interest Company

WebsiteLinkedInAll Job Openings

11 - 50 employees

⚕️ Healthcare Insurance

🤖 Artificial Intelligence

🤝 B2B

Healthcare Insurance • Artificial Intelligence • B2B

The Public Interest Company is a healthcare recovery firm that leverages predictive data science and AI/ML to identify claims that should have been paid by third-party insurers and to recover those funds for payers. It works with health plans, risk-bearing provider groups, self-funded employers, and public sector organizations using an all-upside, contingency model that minimizes risk for clients. The team combines PhD-level data scientists, experienced founders, and litigators to provide technology-driven identification plus relentless legal and recovery strategies, with a focus on returning money to the healthcare system without member abrasion or implementation lag.

📋 Description

• Review medical records, claims data, and supporting documentation to identify potential third-party liability (TPL) and recovery opportunities. • Analyze injury-related claims by connecting accidents, diagnoses, procedures, and treatment timelines. • Apply ICD-10, CPT, and healthcare coding knowledge to evaluate the accuracy and completeness of claims. • Identify patterns, discrepancies, and opportunities for recovery through detailed claims and records review. • Collaborate with operations, product, and engineering teams to improve workflows, review processes, and data quality. • Document findings clearly and consistently to support downstream recovery efforts. • Maintain high standards of accuracy while managing multiple cases in a fast-paced, data-driven environment. • Stay current on coding guidelines, healthcare claims practices, and industry trends to continuously improve review quality.

🎯 Requirements

• Certified Professional Coder (CPC), Certified Coding Specialist (CCS), Certified Outpatient Coder (COC), or equivalent medical coding credential preferred. • Strong knowledge of ICD-10 diagnosis coding; experience with RAF reviews, quality reviews, or health plan coding audits is highly desirable. • Experience reviewing injury-related claims, including personal injury, workers' compensation, auto, or liability claims. • Background working for a health plan, third-party administrator (TPA), medical billing company, or medical records review organization. • Familiarity with healthcare claims data, including Explanation of Benefits (EOBs), remittance advice, CPT and ICD-10 coding, and claims documentation. • Strong analytical skills with exceptional attention to detail and the ability to identify patterns across medical records and claims data. • Comfortable working in structured, data-driven environments and making consistent, evidence-based determinations.

🏖️ Benefits

• Make a meaningful impact by helping ensure healthcare claims are paid accurately and recovering funds that support patient care. • Apply your clinical and coding expertise to solve complex, real-world cases at the intersection of healthcare, data, and legal operations. • Join a collaborative, fast-growing team where your work directly influences product development, operational strategy, and client outcomes. • Grow your career in an innovative healthcare technology company transforming how third-party liability claims are identified and recovered.