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Backend Claims Management Specialist
EverCommerce. Investigate and resolve complex claims, denials, and reimbursement issues .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in Revenue Cycle Management, claims processing, and denial management, with a strong focus on data analysis and operational improvements. Capable of collaborating cross-functionally to enhance client health and optimize reimbursement performance.
Highest-signal resume keywords
Revenue Cycle Management (RCM)Claims ProcessingDenial ManagementData AnalysisPayer Reimbursement Methodologies
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Claims ProcessingDenial ManagementData AnalysisPerformance ReportingRoot Cause AnalysisOperational ImprovementsProcess OptimizationPayer RelationsHealthcare Claims ManagementMedical Billing
Soft Skills
Analytical MindsetStrong Written CommunicationStrong Verbal CommunicationInfluencing SkillsCollaboration
Industry Keywords
Revenue CycleHealthcareClient ServicesOperational EfficiencyAged Accounts ReceivablePayer PoliciesEmerging RisksProcess ImprovementClient RetentionBPO Teams
About the role
Key responsibilities & impact- 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, emerging risks, and opportunities for process improvement
- Partner with internal teams to implement solutions that improve operational efficiency and financial performance
- Partner with Service Managers to improve overall client health and revenue cycle performance
- Present findings, recommendations, and performance trends to internal stakeholders
- Support client retention through proactive issue resolution and operational improvements
- Provide guidance and training to BPO teams on claims processing and denial prevention best practices
- Develop and promote standardized processes that improve quality and consistency
- Collaborate cross-functionally with Revenue Cycle, Operations, and Client Services teams to drive continuous improvement
Requirements
What you’ll need- 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 with the ability to identify trends, perform root cause analysis, and recommend solutions
- Strong written and verbal communication skills with the ability to influence cross-functional teams
- Proficiency in data analysis and performance reporting
- Experience in healthcare revenue cycle operations, denial prevention, appeals, or payer relations preferred
- Experience driving operational improvements and process optimization preferred
- Must be eligible to work without sponsorship in the United States
Benefits
Comp & perks- Flexibility to work where/how you want within your country of employment – in-office, remote, or hybrid
- Continued investment in your professional development
- Day 1 access to a robust health and wellness benefits package, including an annual wellness stipend
- 401k with up to a 4% match and immediate vesting
- Flexible and generous (FTO) time-off
- Employee Stock Purchase Program