Jr Payment Integrity Analyst

About CoverSelf:

CoverSelf empowers US healthcare payers with a truly next-generation, cloud-native, holistic, and customizable platform designed to prevent and adapt to the ever-evolving inaccuracies in healthcare claims and payments. By reducing complexity and administrative costs, we offer a unified, healthcare-dedicated platform backed by top VCs like BeeNext, 3One4 Capital, and Z21 Ventures.

Position Overview:

This role focuses on developing clinical content, payment integrity rules, and code edit solutions. The Clinical Content Specialist will translate clinical guidelines and payer policies into business logic, algorithms, and rule frameworks for automated claims validation.

Key Responsibilities:

• Develop and maintain payment integrity rules, edits, and policies
• Translate Healthcare Payer guidelines business rules
• Build code edit solutions to detect incorrect payments
• Conduct research on medical policies and reimbursement methodologies

Requirements:

• Passionate about working in the clinical domain, with a focus on learning and growth
• Strong foundation in clinical concepts, Ability to convert clinical guidelines into logical rules
• Demonstrated experience in research work, college thesis, or complex case study analysis
• Strong research mindset with the ability to interpret clinical and medical literature
• Excellent communication, articulation, and interpretation skills
• Ability to translate complex clinical information into clear and structured insights
• Sound clinical knowledge with attention to detail and accuracy
• Support the configuration of payment integrity rules/solutions based on business requirements.
• Assist with testing configured rules and validating results to ensure expected outcomes.

Qualifications

Education Certification (one of the following required):

• Medical Degree (e.g., MBBS, BDS, BPT, BAMS etc)
• Nursing: Bachelor/Master of Science in Nursing
• Pharmacist Degree (B.Pharm, M.Pharm or PharmD)
• Life Science -Bachelor/Master

Certification Requirements:

• Must hold any of the following certifications: CPC, CPMA, COC, CIC, CPC-P, CCS or any specialty certifications from AHIMA or AAPC.

Experience:

Freshers with a strong foundation in Pharmacy/Clinical concepts and a research mindset can be considered.

Key Skills:

• Strong analytical interpretation skills
• Excellent verbal written communication skills.
• Excellent Interpretation and articulation skills
• Strong analytical, critical thinking, and problem-solving skills
• Willingness to learn new products and tools

Work Details:

• Location: Jayanagar, Bangalore
• Mode: Work from Office

Benefits:

• Best-in-class compensation
• Health insurance for Family
• Personal Accident Insurance
• Friendly and Flexible Leave Policy
• Certification and Course Reimbursement
• Medical Coding CEUs and Membership Renewals
• Health checkup
• And many more!

Our Commitment to Diversity:

At CoverSelf, we are building a global workplace where every individual can discover their true potential, passion, and purpose - regardless of background, gender, race, sexual orientation, religion, or ethnicity. We believe a diverse workplace fosters innovation, creativity, and progress for our employees, communities, and business.

Disclaimer: This job posting has been aggregated from external source. Role details, content, and availability are subject to change. Applicants are advised to confirm the latest information directly on the company website before applying.