Senior Claims Reviewer

About Arlo

The Opportunity

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

• 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

Compensation