by twochickswithasidehustle | Jun 16, 2026 | Uncategorized
Description
About Us
At Gifthealth, we’re revolutionizing the way people experience healthcare by simplifying the process of managing prescriptions and health services. Our mission is to provide a seamless, personalized, and efficient healthcare experience for all our customers. We’re a dynamic, innovative, and customer-centric company dedicated to making a positive impact on people’s lives.
Position Summary
A Reimbursement Analyst is responsible for being the primary point of contact in assisting patients or healthcare providers in obtaining access to therapy for the reimbursement hub program to which they are assigned. Primary activities may include researching and analyzing moderate to complex reimbursement policies, billing, benefit investigations, prior authorization, appeals and patient assistance support programs. Responsibilities, may include interactions with client contacts as well as handling of escalated cases/issues.
Key Responsibilities
- Assist patients and healthcare providers with moderate to complex billing and coding, insurance benefit investigations, prior authorization, appeals and patient assistance support programs inquiries.
- May include acting as regional contact for senior level client contacts.
- Manage patient cases and interact with external contacts like payers and other stakeholders.
- Assist with coordination of relevant tasks/activities between Gifthealth and the client.
- Review and resolve denied or underpaid insurance claims.
- Identify and assess patient specific insurance coverage options for client specific products.
- Reverify patient benefits at predetermined time frames
- Document all activities in program database within required timelines.
- Research payer medical policy
- Monitor and update payer prior authorization requirements and coverage policies for specified client program.
- Prepare and/or assist with preparation of reports as requested, including adverse event and product complaint reports.
- Review and process documentation to determine patient specific eligibility for client patient support program(s), as appropriate.
- Complete quality monitoring and quality assurance activities, as assigned.
- Travel to and attend client meetings, off-site training, and/or conferences. Travel time estimate: 5%.
Qualifications
- Minimum four years recent healthcare experience (2 years’ direct industry preferred).
- Exhibit proficiency in Microsoft Office products
- Excellent customer service skills (call center experience preferred).
- Advanced problem solving, research and analytical skills.
- Advanced communication skills, both written and verbal.
- Attention to detail, data entry accuracy required.
- Ability to multi-task and manage time independently.
- Client interaction experience preferred.
- Advanced knowledge of medical insurance (public and commercial), billing and
- coding and associated terminology.
Work Environment
- Location: Remote
- Schedule: Full-time
- May require availability or flexibility for escalations.
- Regular meetings with teams, departments, or leadership to ensure alignment.
Key Essential Functions
- Ability to sit for extended periods of time while working at a computer and on the phone throughout the workday.
- Ability to engage in continuous phone and computer use, including navigating multiple systems simultaneously, for the duration of the shift.
- Ability to perform repetitive motions for an entire shift, including typing, mouse use, and phone handling.
- Ability to view and read information on a computer screen for prolonged periods.
- Ability to communicate clearly and professionally via phone, email, and internal systems.
- Ability to manage a high volume of inbound and outbound calls while maintaining attention to detail and accuracy.
- Ability to work in a remote environment with minimal distractions and maintain productivity and performance standards.
- Ability to adapt to changing priorities, workflows, and processes in a fast-paced environment.
- Ability to meet attendance, schedule adherence, and performance expectations, including flexibility for occasional extended hours or weekends as business needs require.
Employment Classification
Status: Full-time
FLSA: Non-Exempt
Equal Employment Opportunity (EEO) Statement
Gifthealth is an Equal Opportunity Employer and prohibits discrimination and harassment of any kind. All employment decisions are made without regard to race, color, religion, sex, sexual orientation, gender identity, transgender status, national origin, age, disability, veteran status, or any other legally protected status.
We celebrate diversity and are committed to creating an inclusive environment for all employees. If you do not meet every requirement but still feel you would be a great fit for this role, we encourage you to apply!
Disclaimer
This job description is intended to describe the general nature and level of work being performed. It is not intended to be an exhaustive list of all responsibilities, duties, or skills required of personnel. Gifthealth reserves the right to modify job duties or descriptions at any time.
Salary Description
$24.81 – $29.18
by twochickswithasidehustle | Jun 16, 2026 | Uncategorized
For roles that are 100% remote or hybrid, you must have access to a reliable high-speed internet connection to support daily job responsibilities. A minimum bandwidth of 50 Mbps download and 5 Mbps upload is required. Those fully remote associates residing in states where service is required by contract, law, or regulation will be allowed to submit for reimbursement.
Your career starts now. We’re looking for the next generation of health care leaders.
At AmeriHealth Caritas, we’re passionate about helping people get care, stay well and build healthy communities. As one of the nation’s leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we’d like to hear from you.
Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.
Discover more about us at www.amerihealthcaritas.com.
Job Summary
The Appeals & Grievance Case Resolution Specialist is responsible for the full life cycle of assigned member and/or provider appeals and grievance cases. Working under general supervision, this role conducts case intake, investigation, and documentation to ensure accurate and timely resolution consistent with federal state, and accreditation standards. The Specialist serves as a key liaison between members, providers, and internal departments to resolve issues effectively, ensuring the integrity of the appeals and grievance process and compliance with CMS, NCQA, URAC, and state regulatory requirements.
Essential Functions
Case Management
- Research and analyze case documentation, including benefit coverage, prior authorizations, claims, and regulatory guidance.
- Communicate with members, providers, or representative to clarify appeal intent and gather missing documentation including incoming calls, outgoing calls, and phone queue work as assigned.
- Prepare complete and compliant case files, ensuring all required documentation is included.
- Track case progress and maintain compliance with turnaround times and documentation standards.
- Generate accurate and timely determination and acknowledgement letters.
Investigation and Resolution
- Collaborate with internal departments such as Claims, Medical Management, Legal, and Compliance to obtain necessary information for resolution.
- Identify potential compliance issues or risk factors requiring escalation.
- Participate in case discussions, internal committee reviews, or external fair hearing preparation as assigned.
- Document all activities, correspondence, and outcomes in the case management system with attention to detail and accuracy.
Compliance & Quality
- Ensure case handling meets all application federal and state regulatory requirements, including with CMS, NCQA, and URAC.
- Maintain confidentiality and protect member information in compliance with HIPPA regulations.
- Identify opportunities for process improvements to enhance quality and efficiency.
Team Collaboration
- Serve as a resource to peers and administrators for routine case-related questions.
- Maintain professional communication with members, providers, and internal stakeholders.
- Participate in team meetings and contribute to continuous improvement initiatives.
Education/Experience
- Associate’s Degree: in Health Administration, Business, or related field preferred
- High School Diploma/GES Required
Preferred Experience Level:
- Knowledge of medical terminology, benefit interpretation, and regulatory processes preferred. Prior experience working with CMS, Medicaid, or state-regulated appeals processes preferred.
- 2 to 3 years experience in healthcare operations, managed care, or grievance/appeals coordination.
Other Skills
- Proficiency in Microsoft Office Suite (Word, Excel, Outlook, etc.).
- Strong attention to detail and organization.
- Excellent written and verbal communication.
- Ability to manage multiple priorities in a fast-paced environment.
- Strong analytical and problem-solving abilities.
- Customer service orientation with professional communication etiquette.
Our Comprehensive Benefits Package
Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more.
by twochickswithasidehustle | Jun 16, 2026 | Uncategorized
Application
About Finch
We believe every American household deserves access to counsel in life’s biggest moments. At Finch, we’re building the infrastructure to make justice radically more accessible. Our modern approach to consumer law automates the admin work and puts clients first, starting with personal injury.
In just over a year, we’ve grown 10x, raised a $20M Series A, and become the pre-litigation partner of choice for top personal injury firms across the country. We believe the best outcomes happen when expert operators and purpose-built AI work together – which is why we handle every step of pre-lit, from intake and claim opening to medical records, lien management, and demands, with humans leading every case.
We’re backed by Sequoia, Redpoint, and the founders & CEOs of generational companies like DoorDash, Ironclad, and Digits. We’re rebuilding how the law serves everyday Americans from first principles, and we’re hiring exceptional operators to help us scale it nationwide.
This Role
As an Intake Data Entry Specialist you’ll own the accuracy, completeness, and flow of all incoming case data. This role sits at the front of the funnel—ensuring every case is set up correctly from day one and ready to move quickly through the system.
You’ll play a critical role in maintaining a clean, reliable Case Management System by validating, structuring, and updating intake data in real time. If you’re detail-oriented, process-driven, and thrive in fast-paced environments where precision matters, this role is for you.
What You’ll Do
- Own Intake Data Accuracy: Review, validate, and enter new case information (client details, incident data, documentation) with a high level of precision.
- Set up cases for success: Ensure every new case is properly created, structured, and aligned with firm standards
- Manage in real time: Process intake updates quickly to keep cases moving without delays
- Maintain consistency across systems: Ensure alignment between intake tools, Finch, and partner firm systems
- Identify and resolve issues early: Partner with intake and operations teams to flag and fix missing or inconsistent data
- Keep clean records: Document updates and changes to maintain transparency and auditability
- Continuously improve processes: Look for ways to increase speed, accuracy, and efficiency in intake workflows
You Might Be a Fit if You
- Have a proven track record in task management, or a related field
- Have strong attention to detail—you catch what others miss
- Can move quickly without sacrificing accuracy
- Are comfortable working across multiple systems and tools
- Are highly organized with strong process discipline
- Communicate clearly and collaborate well across teams
- Are adaptable and open to evolving workflows and systems
Compensation
$50,000 to $60,000 annual salary
Additional Benefits Include
• 100% coverage for health, dental, and vision
• 401(k) retirement plan
• In-office snacks, drinks, and daily team lunch and dinners
• Flexible PTO (we trust you to take the time you need)
At Finch Legal, we believe in practicing what we advocate.
As a company dedicated to upholding justice and protecting people in the workplace, we are equally committed to fostering a safe, inclusive, and equitable environment within our own walls. We welcome and support individuals from all backgrounds and lived experiences — regardless of race, ethnicity, gender identity, sexual orientation, religion, disability, or veteran status.
We recognize that diversity strengthens our team, enriches our perspectives, and empowers us to better serve our clients and communities. At Finch Legal, inclusion isn’t just a value — it’s a practice.
by twochickswithasidehustle | Jun 16, 2026 | Uncategorized
For roles that are 100% remote or hybrid, you must have access to a reliable high-speed internet connection to support daily job responsibilities. A minimum bandwidth of 50 Mbps download and 5 Mbps upload is required. Those fully remote associates residing in states where service is required by contract, law, or regulation will be allowed to submit for reimbursement.
Your career starts now. We’re looking for the next generation of health care leaders.
At AmeriHealth Caritas, we’re passionate about helping people get care, stay well and build healthy communities. As one of the nation’s leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we’d like to hear from you.
Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.
Discover more about us at www.amerihealthcaritas.com.
Job Summary
The Appeals & Grievance Case Resolution Specialist is responsible for the full life cycle of assigned member and/or provider appeals and grievance cases. Working under general supervision, this role conducts case intake, investigation, and documentation to ensure accurate and timely resolution consistent with federal state, and accreditation standards. The Specialist serves as a key liaison between members, providers, and internal departments to resolve issues effectively, ensuring the integrity of the appeals and grievance process and compliance with CMS, NCQA, URAC, and state regulatory requirements.
Essential Functions
Case Management
- Research and analyze case documentation, including benefit coverage, prior authorizations, claims, and regulatory guidance.
- Communicate with members, providers, or representative to clarify appeal intent and gather missing documentation including incoming calls, outgoing calls, and phone queue work as assigned.
- Prepare complete and compliant case files, ensuring all required documentation is included.
- Track case progress and maintain compliance with turnaround times and documentation standards.
- Generate accurate and timely determination and acknowledgement letters.
Investigation and Resolution
- Collaborate with internal departments such as Claims, Medical Management, Legal, and Compliance to obtain necessary information for resolution.
- Identify potential compliance issues or risk factors requiring escalation.
- Participate in case discussions, internal committee reviews, or external fair hearing preparation as assigned.
- Document all activities, correspondence, and outcomes in the case management system with attention to detail and accuracy.
Compliance & Quality
- Ensure case handling meets all application federal and state regulatory requirements, including with CMS, NCQA, and URAC.
- Maintain confidentiality and protect member information in compliance with HIPPA regulations.
- Identify opportunities for process improvements to enhance quality and efficiency.
Team Collaboration
- Serve as a resource to peers and administrators for routine case-related questions.
- Maintain professional communication with members, providers, and internal stakeholders.
- Participate in team meetings and contribute to continuous improvement initiatives.
Education/Experience
- Associate’s Degree: in Health Administration, Business, or related field preferred
- High School Diploma/GES Required
Preferred Experience Level:
- Knowledge of medical terminology, benefit interpretation, and regulatory processes preferred. Prior experience working with CMS, Medicaid, or state-regulated appeals processes preferred.
- 2 to 3 years experience in healthcare operations, managed care, or grievance/appeals coordination.
Other Skills
- Proficiency in Microsoft Office Suite (Word, Excel, Outlook, etc.).
- Strong attention to detail and organization.
- Excellent written and verbal communication.
- Ability to manage multiple priorities in a fast-paced environment.
- Strong analytical and problem-solving abilities.
- Customer service orientation with professional communication etiquette.
Our Comprehensive Benefits Package
Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more.
by twochickswithasidehustle | Jun 16, 2026 | Uncategorized
locationsUS – Remotetime typeFull timeposted onPosted Yesterdayjob requisition idJR105326
About Us:
Our purpose is to help clients exceed their financial health goals. Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals.
We build long-term careers by investing in YOU. We seek to create an environment that cultivates your professional development and personal growth, as we believe your success is our success.
JOB SUMMARY:CDI Specialists will collaborate extensively with physicians, nursing staff, other patient caregivers, and medical records coding staff to improve the quality, specificity, accuracy and completeness of the documentation of care provided and coded. CDI Specialist will review medical records for opportunities for diagnosis clarification and validity as it pertains to DRG assignment, severity of illness, risk of mortality, and case mix data as well as timely, accurate and complete documentation of clinical information used for measuring and reporting physician and facility outcomes. These goals will be accomplished by chart review and query placement when appropriate following AHIMA guidelines and CorroHealth policies and procedures.
This is a remote position
ESSENTIAL DUTIES AND RESPONSIBILITIES:
Note: The essential duties and responsibilities below are intended to describe the general duties and responsibilities of this position and are not intended to be an exhaustive statement of duties. This position may perform all or most of the primary duties listed below. Specific tasks, responsibilities or competencies may be documented in the Team Member’s performance objectives as outlined by the Team Member’s immediate Leadership Team Member.
Essential Duties and Responsibilities:
- Review outpatient encounters (pre visit, concurrent, and/or post visit) to assess documentation accuracy and completeness.
- Identify opportunities for improved documentation related to: Chronic conditions and disease specificity Risk adjustment (e.g., HCCs)Quality measures and medical necessity.
- Provide compliant documentation clarification via query and feedback to providers through approved communication channels Support accurate problem list management and ongoing condition validation.
- Collaborate with coding, quality, compliance, and revenue cycle teams as needed.
- Track and report CDI interventions, trends, and outcomes. Participate in provider education and training initiatives.
- Stay current on outpatient coding, risk adjustment, and regulatory guidanceCompliance & Regulatory OversightEnsure compliance with CMS, payer, and organizational documentation and billing requirements.
- Identify potential compliance risks, including but not limited to overcoding, undercoding, and missing and/or unsupported diagnoses. Apply knowledge of HCCs, risk adjustment, quality measures, and outpatient reimbursement methodologies as applicable.
Minimum Qualifications:
- An active coding credential required such as – RHIA, RHIT, CPC, COC, CCS-O, CCS, CDEO, CCDS, CDIP or CCDS-O
- 3+ years of outpatient coding, risk adjustment, outpatient CDI. Strong understanding of:ICD‑10‑CM outpatient coding Risk adjustment models (e.g., Medicare Advantage HCCs)Outpatient E/M documentation requirements.
- Experience working in an ambulatory EHR (Epic, Cerner, or similar)
Skills & Competencies:
- Strong clinical and analytical judgment.
- Professional communication style.
- Excellent written documentation skills. Comfortable working independently in a fast-paced environment.
- Proficient in Microsoft Office Applications
Desired Minimum Qualifications:
- Experience with telecommuting, working with EMRs and other electronic tools.
- Strong analytical skills.
- Strong Microsoft Office skills.
- Works well with numbers.
- Strong team player.
- Ability to work with multiple and diverse clients and projects.
- Ability to work with minimal supervision.
- Ability to maintain and access multiple files.
- Assure that work product is completed with high levels of accuracy and attention to detail.
This is a remote position
PHYSICAL DEMANDS:
Note: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions as described. Regular eye-hand coordination and manual dexterity is required to operate office equipment. The ability to perform work at a computer terminal for 6-8 hours a day and function in an environment with constant interruptions is required. At times, Team Members are subject to sitting for prolonged periods. Infrequently, Team Member must be able to lift and move material weighing up to 20 lbs. Team Member may experience elevated levels of stress during periods of increased activity and with work entailing multiple deadlines.
A job description is only intended as a guideline and is only part of the Team Member’s function. The company has reviewed this job description to ensure that the essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.
by twochickswithasidehustle | Jun 16, 2026 | Uncategorized
About Reserv
Reserv is an insurtech creating and incubating cutting-edge AI and automation technology to bring efficiency and simplicity to claims. Founded by insurtech veterans with deep experience in SaaS and digital claims, Reserv is venture-backed by Bain Capital and Altai Ventures and began operations in May 2022. We are focused on automating highly manual tasks to tackle long-standing problems in claims and set a new standard for TPAs, insurance technology providers, and adjusters alike. We have ambitious (but attainable!) goals and need people who can work in an evolving environment. If building a leading TPA and the prospect of tackling the long-standing challenges of the claims role sounds exciting, we can’t wait to meet you.
About the role
At Reserv, we’re reimagining what modern claims handling can be — faster, smarter, and relentlessly customer‑centric. As our Claims Director, you’ll lead a team of Claims Professionals managing real property and auto damage claims, bodily injury claims, driving operational excellence through technology, analytics, and a deep commitment to customer experience.
You’ll own the full customer journey, ensuring every interaction is seamless, empathetic, and efficient. This role blends strategic leadership with hands‑on execution, requiring someone who can inspire teams, influence cross‑functional partners, and scale a claims operation built for the future.
What You’ll Do
Customer Experience & Strategy
- Develop and execute a comprehensive customer experience strategy aligned with Reserv’s mission and growth goals.
- Define KPIs and performance metrics to drive satisfaction, retention, and overall experience quality.
- Identify emerging trends and technologies to continuously evolve our claims experience.
- Act as the voice of the customer in key business decisions.
Leadership & Team Development
- Build, lead, and develop a high‑performing claims team.
- Oversee recruitment, onboarding, coaching, and ongoing professional development.
- Conduct regular performance evaluations and foster a culture of excellence, innovation, and accountability.
- Design and implement training programs to strengthen technical, insurance, and customer service skills.
Operational Excellence
- Serve as the escalation point for complex or sensitive customer issues, providing strategic guidance and resolution.
- Use data, analytics, and customer feedback to identify pain points and implement improvements.
- Partner with Product and Engineering to inform the development of tools, systems, and processes that enhance efficiency and outcomes.
- Ensure scalable, compliant, and efficient operations across all claims workflows.
Cross‑Functional Collaboration
- Work closely with leaders across Claims Operations, Product, Engineering, and Marketing to drive customer‑centric initiatives.
- Influence organizational priorities and ensure alignment with broader business objectives.
Requirements
- Bachelor’s degree in business, marketing, communications, or a related field (advanced degree preferred).
- 10+ years of experience in insurance claims across multiple lines; property and/or auto strongly preferred.
- 5+ years of management experience, ideally leading remote teams.
- Proven ability to deliver results, overcome obstacles, and drive continuous improvement.
Benefits
- Generous health-insurance package with nationwide coverage, vision, & dental
- 401(k) retirement plan with employer matching
- Competitive PTO policy – we want our employees fresh, healthy, happy, and energized!
- Generous family leave policy after 8 months of continuous work
- Work from anywhere to facilitate your work life balance
- Apple laptop, large second monitor, and other quality-of-life equipment you may want. Technology is something that should make your life easier, not harder!
Additionally, we will
- Listen to your feedback to enhance and improve upon the long-standing challenges of an adjuster and the claims role
- Work toward reducing and eliminating all the administrative work from an adjuster role
- Foster a culture of empathy, transparency, and empowerment in a remote-first environment
At Reserv, we value diversity in backgrounds, perspectives, and life experiences and believe that diversity in viewpoints and critical thinking drives innovation, first-principles thinking, and success. We welcome applicants from all backgrounds and encourage those from all walks of life to apply. If you believe you are a good fit for this role, we would love to hear from you!
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