Claims Operations Specialist
Vida Health
Operations
United States
Posted on Oct 27, 2025
We are seeking a detail-oriented Claims Operations Specialist to own the end-to-end billing process for both medical and pharmacy claims. This role oversees claim submission, tracking, reconciliation and serves as a key point of contact for internal teams and clients. The ideal candidate is a quick learner with strong analytical skills and a desire to grow in a fast-paced, non-traditional healthcare environment. Experience with digital health, S-codes or pharmacy claims is a plus.
Responsibilities:
- Oversee the full revenue cycle process for both medical and pharmacy claims, including submission, QA, payment posting and AR follow-up.
- Review, investigate and resolve claim denials and rejections to ensure timely and accurate reimbursement.
- Assist with client onboarding, including claims setup, payer integration, Candid configuration and rules engine alignment.
- Perform monthly billing operations such as claims reconciliation, bank reconciliation and revenue validation.
- Serve as a point of contact for clients, participating in onboarding calls, monthly check-ins and responding to billing questions.
- Collaborate with Sales, Product, Data and Client Success teams on RFPs, internal process updates and issue resolution.
Qualifications:
- Bachelor’s degree in Healthcare Administration, Business or a related field, or equivalent practical experience.
- CPB, CRCS or CMRS strongly preferred.
- 4+ years of experience in revenue cycle management, medical billing or claims operations.
- Experience in the digital health space is a plus.
- Prior experience using Candid or similar RCM platforms is preferred.
- Advanced Excel skills (e.g., pivot tables,VLOOKUP, formulas).
- Familiarity with BigQuery, Looker, NetSuite and Candid.
- Understanding of general healthcare reimbursement principles.
- Familiarity with pharmacy claims and/or alternative coding (eg., S-codes) preferred.
- Self-starter with a proactive approach to problem-solving.
- Strong analytical mindset with the ability to work through ambiguity.
- Comfortable working independently with minimal direction.
- Strong attention to detail and accountability for high-quality work.
- Effective communicator with experience engaging clients directly.