Arlo · 2 months ago
Senior Claims Reviewer
United States
Full-time
Remote
Senior Level
$75K/yr - $100K/yr
5+ years expArlo is a company focused on making health coverage simple and affordable. They are seeking an experienced Claims Reviewer to join their operations team, responsible for reviewing and adjudicating complex medical claims while identifying opportunities for cost containment and fraud prevention.
Health CareHealth InsuranceInsurance
Responsibilities
Review stop-loss and large medical claims for accuracy, completeness, and compliance with plan terms
Adjust and re-adjudicate claims where errors, inappropriate billing, or overpayments are identified
Investigate potentially fraudulent or wasteful claims by analyzing billing patterns, provider behavior, and coding anomalies
Collaborate with cost containment partners, networks, and TPAs to validate billed charges and recover overpayments
Use data and reporting tools to spot trends, anomalies, and emerging risk areas in claims submissions
Provide detailed documentation and recommendations for denials, reimbursements, or escalations
Support process improvement initiatives and help refine Arlo’s claims review and cost containment protocols
Qualification
Required
5+ years of experience in medical or stop-loss claims review, audit, or adjudication
Meticulous, analytical, and detail-oriented — you take pride in accuracy and root-cause thinking
Experienced in identifying inappropriate billing, duplicate charges, and coding errors (ICD-10, CPT, HCPCS, DRG)
Comfortable communicating with TPAs, providers, and internal stakeholders to resolve discrepancies
In-depth understanding of plan design, coordination of benefits, subrogation, and provider billing practices
Familiarity with fraud, waste, and abuse (FWA) detection
Strong working knowledge of claims processing systems and supporting tools (Excel, SQL, Python)
Bachelor's degree or equivalent experience in healthcare administration, insurance, or a related field
Benefits
100% covered health insurance
Vision
Dental & life insurance
Remote work setup stipend
In-office meals
Company
Arlo
Join hundreds of businesses who trust Arlo to offer health insurance that works the way it should: affordable coverage that puts employees and their doctors in the driving seat.
11-50 employees
Funding
Current Stage
Early StageTotal Funding
$4MKey Investors
Upfront Ventures
2025-03-25Seed· $4M
Leadership Team
Karthik Bhaskara
Co-Founder
Recent News
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