The Role
Reviews, validates, and processes discount claims, including manual queue triage and approval or denial decisions. Investigates denial patterns, performs root-cause analysis, reconciles claim data across reports, and recommends workflow or rule improvements. Collaborates with operations and engineering teams on automation opportunities, SOPs, and QA frameworks. Communicates claim decisions to veterinary clinics and pharmaceutical partners while resolving inquiries and maintaining service quality.
Summary Generated by Built In
About the role:
We're hiring a Claims Operations Analyst to join our newly formed claims operations team. Reporting to the Claims Operations Manager, you will be responsible for the daily review and validation of discount claims, flagging process gaps, and contributing to the continuous improvement of our claims workflows. This is an early-stage role where you will help shape operations from the ground up.
Apply if you’re excited to:
- Review, validate, and process discount claims daily, including triaging the Manual Review Queue for flagged claims and making approval or denial decisions based on program eligibility rules.
- Investigate denial patterns and claim exceptions by performing root cause analysis and recommending process or rule adjustments to reduce resubmission rates.
- Support reconciliation activities by verifying claim data accuracy across clinic, program, and reimbursement reports.
- Collaborate with the Claims Operations Manager and engineering teams to document workflow gaps, suggest automation opportunities, and contribute to SOP and QA framework development.
About You:
- Bachelor's degree in Business Administration, Information Technology, Computer Science, or a related field.
- 2–4 years of experience in claims processing, payment reconciliation, or operations (healthcare, insurance, fintech, SaaS).
- Solid understanding of claims adjudication workflows, including approval, denial, exception handling, and remediation processes.
- Experience with queue-based service management platforms (e.g., Jira Service Management, Zendesk, ServiceNow) for queue management, claim workflows, and SLA tracking.
- Strong analytical and problem-solving abilities with a detail-oriented and process-driven mindset.
- Excellent written and verbal communication skills with the ability to clearly document decisions, escalate issues, and coordinate across technical and non-technical stakeholders.
- Serve as a professional point of contact for veterinary clinics and pharmaceutical partners, clearly communicating claim decisions, resolving inquiries, and ensuring a positive and trusted customer experience.
Skills Required
- Bachelor's degree in Business Administration, Information Technology, Computer Science, or a related field
- 2-4 years of experience in claims processing, payment reconciliation, or operations
- Understanding of claims adjudication workflows, including approval, denial, exception handling, and remediation
- Experience with queue-based service management platforms such as Jira Service Management, Zendesk, or ServiceNow
- Strong analytical and problem-solving abilities
- Detail-oriented and process-driven mindset
- Excellent written and verbal communication skills
- Ability to document decisions, escalate issues, and coordinate with technical and non-technical stakeholders
- Ability to communicate with veterinary clinics and pharmaceutical partners, resolve inquiries, and explain claim decisions
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The Company
What We Do
PetDesk offers CRM software for pet care providers to promote pet health.
