Claim Association QA Specialist (Part-Time)
About the Company
The Public Interest Company provides a comprehensive solution for identifying and recovering third party liability for health plans, risk-bearing provider groups, and self-funded employers. We combine AI and a legal tech platform to identify and recover claims that should have been paid by third party payers. We handle the entire recovery process, all while protecting members and streamlining operations. We empower healthcare organizations to maximize their financial performance and recoup dollars towards care delivery, without adding administrative burden.
Role Overview
You'll play a key role in uncovering healthcare claims that should have been paid by third-party insurers rather than health plans. You'll leverage your expertise in medical coding, claims analysis, and clinical documentation to review injury-related cases, identify recovery opportunities, and help improve payment accuracy. This is an ideal opportunity for someone with a strong medical coding or claims background who enjoys investigative work, pattern recognition, and working at the intersection of healthcare, data, and operations.
What You’ll Do
Review medical records, claims data, and supporting documentation to identify potential third-party liability (TPL) and recovery opportunities.
Analyze injury-related claims by connecting accidents, diagnoses, procedures, and treatment timelines.
Apply ICD-10, CPT, and healthcare coding knowledge to evaluate the accuracy and completeness of claims.
Identify patterns, discrepancies, and opportunities for recovery through detailed claims and records review.
Collaborate with operations, product, and engineering teams to improve workflows, review processes, and data quality.
Document findings clearly and consistently to support downstream recovery efforts.
Maintain high standards of accuracy while managing multiple cases in a fast-paced, data-driven environment.
Stay current on coding guidelines, healthcare claims practices, and industry trends to continuously improve review quality.
What We’re Looking For
Certified Professional Coder (CPC), Certified Coding Specialist (CCS), Certified Outpatient Coder (COC), or equivalent medical coding credential preferred.
Strong knowledge of ICD-10 diagnosis coding; experience with RAF reviews, quality reviews, or health plan coding audits is highly desirable.
Experience reviewing injury-related claims, including personal injury, workers' compensation, auto, or liability claims.
Background working for a health plan, third-party administrator (TPA), medical billing company, or medical records review organization.
Familiarity with healthcare claims data, including Explanation of Benefits (EOBs), remittance advice, CPT and ICD-10 coding, and claims documentation.
Strong analytical skills with exceptional attention to detail and the ability to identify patterns across medical records and claims data.
Comfortable working in structured, data-driven environments and making consistent, evidence-based determinations.
Nice to have:
Experience with subrogation or third-party liability (TPL) claims.
Background in utilization review, clinical auditing, or healthcare quality assurance.
Experience in a medical-legal setting, such as a personal injury law firm, medical records review organization, or paralegal role supporting injury-related claims.
Why This Role
Make a meaningful impact by helping ensure healthcare claims are paid accurately and recovering funds that support patient care.
Apply your clinical and coding expertise to solve complex, real-world cases at the intersection of healthcare, data, and legal operations.
Join a collaborative, fast-growing team where your work directly influences product development, operational strategy, and client outcomes.
Grow your career in an innovative healthcare technology company transforming how third-party liability claims are identified and recovered.