Claims Specialist

Claims Specialist Remote | Full-Time Base pay range $20.00/hr - $26.00/hr About Zaya Zaya Care is a venture‑backed startup with a mission to establish a new standard of affordable prevention and recovery care, beyond the hospital setting. Zaya champions the voices of small private practices in an industry dominated by large health systems. Through strategic partnerships with insurance carriers and our technology platform, we eliminate the risk and administrative hurdles associated with insurance, enabling entrepreneurial providers to launch and grow successful in‑network practices, ultimately increasing access to affordable healthcare across the US. About the role As a Claims Specialist, you will manage processing of healthcare claims – including reviewing, investigating, and resolving claim issues (rejections + denials) in a timely manner. This role requires strong attention to detail, excellent communication skills, along with working knowledge of payer policies and procedures. In addition to day‑to‑day claim operations, the Claims Specialist will help develop and maintain clear SOPs to support consistent and compliant claims handling across the organization. Responsibilities Make outbound calls to payer representatives or supervisors to clarify the cause of claim denials and gather any missing information. Correct and resubmit claims when errors are identified, using your knowledge of CMS‑1500 requirements as well as common coding, data, and policy issues. Prepare and submit appeal letters for denied claims (when necessary), ensuring all documentation aligns with each insurer’s medical policies and guidelines. Verify that all patient and claim information in the system is accurate and current, and follow up with the appropriate team members when discrepancies arise. Manage daily claim work by prioritizing tasks based on claim age and urgency. About You Healthcare Knowledgeable: You have a background in medical billing or healthcare operations, with at least 2 years of experience handling claims, benefits, and patient financial responsibilities. Process‑Oriented: You bring strong organizational skills, think operationally, and work through issues thoroughly without leaving loose ends. Adaptable: You’re comfortable working in a dynamic start‑up environment where priorities may shift from week to week. Collaborative: You work well with others, value team success, and are known by colleagues as a reliable and supportive partner. Tech‑Savvy: You communicate effectively across chat (ie Slack), email, and phone. You’re comfortable using digital tools to complete your work. What we Offer Salary range: $20‑$26/hour DOE Medical, Dental and Vision Insurance Unlimited PTO and company‑wide week off during winter holidays Opportunity for impact: As an early team member joining during Seed stage, you’ll be an integral player in bringing our vision to life. Our Values Move with urgency and focus: We act quickly and prioritize what matters most. Speed is important, but never at the cost of clarity or impact. Own the outcome, start to finish: You are accountable for delivering results. If something’s off track, raise it early and drive it to resolution. Be the expert in your craft: Strive to deeply understand your domain. Aim to be the person others turn to for insight, execution, and leadership. Work as one aligned team: We collaborate closely, communicate openly, and support each other. Success is shared, not siloed. Feedback fuels excellence: If something’s unclear, off‑track, or going well - say it early and with care. We name issues before they fester, assume good intent, and stay open when feedback comes our way. It’s how we grow, improve and build a culture of trust. Build for continuity: Set up your work so the team can succeed even if you’re out. Strong systems don’t rely on one person. They create long‑term clarity, consistency, and impact. Equal Opportunity Employment Notice Zaya Care is an equal opportunity employer and we value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status. Seniority level Entry level Employment type Full‑time Job function Finance, Other, and Analyst #J-18808-Ljbffr