[Hiring] Backend Claims Management Specialist @EverCommerce

Role Description

The Backend Claims Management Specialist enables timely claim resolution by providing operational expertise, strategic guidance, and educational support focused on backend revenue cycle performance. This role partners closely with Service Managers and BPO teams to identify barriers to payment, analyze denial trends, improve claim outcomes, and drive overall client health through data-driven recommendations.

Key Responsibilities

• Revenue Cycle & Claims Management
  • Investigate and resolve complex claims, denials, and reimbursement issues.
  • Analyze denial trends and identify root causes to improve claim outcomes.
  • Support reduction of aged accounts receivable and optimize reimbursement performance.
  • Escalate complex payer or operational issues as needed.
• Payer & Operational Expertise
  • Develop expertise in payer policies, reimbursement methodologies, and client workflows.
  • Identify payer trends, emerging risks, and opportunities for process improvement.
  • Partner with internal teams to implement solutions that improve operational efficiency and financial performance.
• Customer Success & Performance Improvement
  • Partner with Service Managers to improve overall client health and revenue cycle performance.
  • Present findings, recommendations, and performance trends to internal stakeholders.
  • Support client retention through proactive issue resolution and operational improvements.
• Education & Collaboration
  • Provide guidance and training to BPO teams on claims processing and denial prevention best practices.
  • Develop and promote standardized processes that improve quality and consistency.
  • Collaborate cross-functionally with Revenue Cycle, Operations, and Client Services teams to drive continuous improvement.

Qualifications

• Required
  • Experience in Revenue Cycle Management (RCM), medical billing, or healthcare claims management.
  • Strong knowledge of claims processing, denial management, and payer reimbursement methodologies.
  • Analytical mindset with the ability to identify trends, perform root cause analysis, and recommend solutions.
  • Strong written and verbal communication skills with the ability to influence cross-functional teams.
  • Proficiency in data analysis and performance reporting.
• Preferred
  • Experience in healthcare revenue cycle operations, denial prevention, appeals, or payer relations.
  • Experience driving operational improvements and process optimization.

Benefits

• Flexibility to work where/how you want within your country of employment – in-office, remote, or hybrid.
• Continued investment in your professional development.
• Day 1 access to a robust health and wellness benefits package, including an annual wellness stipend.
• 401k with up to a 4% match and immediate vesting.
• Flexible and generous (FTO) time-off.
• Employee Stock Purchase Program.

Company Description

EverHealth, a business within EverCommerce, provides modern end-to-end solutions for healthcare providers. Our open, connected ecosystem of solutions and services helps providers engage patients, increase revenue, improve business efficiency, and remain market competitive. We serve 72,000 healthcare practices and counting.