Research Policy Analyst to Managers - Semi automated Claims Validation / Payment Integrity

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 Saison Capital.

Position Overview : To play a critical role within the CoverSelf Content team, contributing to the development, enhancement and maintenance of medical policy content. This position is responsible for researching new medical policies, ensuring quality assurance, and identifying opportunities to expand policy libraries. This role will also conduct in-depth reviews of existing medical policies and support the development of clinical logic and algorithms for Semi automated claims review.

We Are Seeking a Passionate And Experienced Subject Matter Expert (SME) With Strong Hands-on Expertise In One Or More Of The Following Areas

• Claims prepayment review
• Payment Integrity
• Clinical Coding Analyst
• Content Development
• Payment Integrity Data mining
• Medical Coding
• Denials Management
• Clinical documentation improvement

Specialty Expertise

Key Responsibilities

Requirements

Qualifications

Education & Certification (one of the following required) :

Certification Requirements

Experience

Key Skills

Work Details

Benefits

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.

Skills Required

Microsoft Word, Denials management, Lcd, PTP, Icd, cms 1500 , Cpt, Content Development, modifiers , Medical Coding