Arlo · 7 hours ago
Senior Claims Reviewer
United States
Full-time
Remote
Mid, Senior Level
$75K/yr - $90K/yr
5+ years expArlo is a company focused on transforming health insurance through AI technology. They are seeking an experienced Claims Reviewer to ensure accurate adjudication of claims, identify opportunities for cost containment, and protect clients by processing claims efficiently and in compliance with plan provisions.
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
High ownership: You’ll get real responsibility from day one—our high-trust team empowers you to run with big problems and shape core parts of the company.
Join an important mission: Your work directly influences how people access care and improves lives at scale.
Growth & expansion: We’re moving fast, and as we grow, your scope will grow with us—new challenges, bigger opportunities, and rapid career velocity.
Apply AI to a problem that matters: Instead of optimizing ads or cutting labor costs, you’ll use AI to fundamentally reimagine how people get healthcare.
High pace, high collaboration: We operate with velocity, first-principles thinking, and a team that works closely, openly, and with ambition.
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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2025-10-28
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2025-03-27
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2025-03-26
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