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Senior Claims Reviewer

Arlo

New York, New York

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JOB DETAILS
SKILLS
Adjudication, Analysis Skills, Artificial Intelligence (AI), Billing, Childcare, Claims Processing, Cost Control, Cross-Functional, Current Procedural Terminology (CPT), Data Science, Database Report Tools, Detail Oriented, Diagnosis-Related Group (DRG), Documentation, Financial Trend Analysis, Fraud Investigation, Health Insurance, Health Plan, Healthcare, Healthcare Common Procedure Coding System (HCPCS), ICD-10, Pattern Analysis, Process Improvement, Python Programming/Scripting Language, Risk, SQL (Structured Query Language), Small Business, Startup, Subrogation, Trend Analysis
LOCATION
New York, New York
POSTED
30+ days ago

About Arlo


AI is changing how people access their health care - but traditional incumbent carriers are far behind. Thousands of people delay care every day, because of financial fear and lack of support from their health insurance to seek the care they need.

Arlo’s mission is to make high-quality health coverage simple, affordable, and transparent — helping employers offer benefits that actually feel like benefits. We’ve grown from zero to tens-of-thousands of covered members in under a year, and we’re just getting started.


The Opportunity


Arlo is hiring for an experienced Claims Reviewer to join our stop-loss and medical claims operations team. This role is responsible for reviewing aggregate claims as well as high-cost and complex claims, ensuring accurate adjudication, and identifying opportunities for cost containment and fraud prevention. You will play a critical part in protecting Arlo’s clients and ensuring every claim is processed accurately, efficiently, and in line with plan provisions.

What you will do


  • 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.


What we are looking for


  • 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.


Why you’ll love it here


  • Mission with Impact: Help small businesses offer health benefits that truly matter.
  • High Impact: You’ll be working cross-functionally with operations and our data science team and your work will be key to building a health insurance company from scratch (where else can you do that??)
  • Fast-Growing Startup: Join us at an inflection point — we’re scaling quickly and thoughtfully.
  • Ownership & Autonomy: We value builders and give you room to create.
    • Compensation:$75,000-100,000 annually
    • Individual Performance based bonus
    • the usual Tech startup benefits (100% covered health insurance, vision, dental & life insurance, remote work setup stipend, in-office meals, etc. etc.)

Process


This is what you can expect when we like your application:
  • 30-minute introductory call with Jan-Felix (CEO & Co-Founder)
  • 30-min call with Karthik (Co-Founder)
  • Take-home case study
  • Onsite/ Virtual Onsite
  • Reference Calls

About the Company

A

Arlo

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