Claim Association QA Specialist (Part-Time)

About the Company

The Public Interest Company offers an end-to-end approach to finding and recovering third-party liability dollars for health plans, risk-bearing provider groups, and self-funded employers. Its AI-powered legal-tech platform is used to spot claims that should have been paid by another party, manage the recovery workflow, and keep member experience and internal operations streamlined. The goal is to help healthcare organizations improve financial performance and recover funds that can be redirected to care, without creating extra administrative work.

Role Overview

In this position, you will help identify healthcare claims that may have been the responsibility of a third-party insurer rather than the health plan. The role relies on medical coding, claims review, and clinical document analysis to examine injury-related cases, find recovery opportunities, and support better payment accuracy. It is suited to someone with a solid background in coding or claims who enjoys investigative work, pattern spotting, and working where healthcare, data, and operations overlap.

What You Will Do

• Examine medical records, claims files, and related documentation to spot possible third-party liability and recovery opportunities.
• Assess injury-related claims by linking accidents, diagnoses, procedures, and treatment timelines.
• Use ICD-10, CPT, and healthcare coding knowledge to judge whether claims are accurate and complete.
• Look for trends, mismatches, and recovery opportunities through detailed review of claims and records.
• Work with operations, product, and engineering teams to strengthen workflows, review methods, and data quality.
• Record findings in a clear, consistent way so downstream recovery work can move forward smoothly.
• Keep a strong focus on accuracy while handling multiple cases in a fast-moving, data-led setting.
• Stay up to date on coding rules, healthcare claims practices, and industry developments to improve review quality over time.

Requirements

• A CPC, CCS, COC, or similar medical coding certification is preferred.
• Strong command of ICD-10 diagnosis coding; experience with RAF reviews, quality reviews, or health plan coding audits is a strong advantage.
• Prior work on injury-related claims, such as personal injury, workers' compensation, auto, or liability cases.
• Experience in a health plan, TPA, medical billing organization, or medical records review team.
• Knowledge of healthcare claims materials such as EOBs, remittance advice, CPT and ICD-10 coding, and claims documentation.
• Excellent analytical ability, with a sharp eye for detail and the capacity to identify patterns across medical records and claims data.
• Comfort in structured, data-driven environments and the ability to make consistent, evidence-based decisions.
• Experience with subrogation or third-party liability claims is a plus.
• Exposure to utilization review, clinical auditing, or healthcare quality assurance is helpful.
• Background in a medical-legal environment, such as a personal injury law firm, medical records review company, or paralegal support role for injury-related matters, is also desirable.

Why This Role

• Contribute to meaningful work that helps ensure healthcare claims are paid correctly and that recovered funds support patient care.
• Apply clinical and coding expertise to solve complex real-world problems at the intersection of healthcare, data, and legal operations.
• Join a collaborative, fast-growing team where your work influences product direction, operations, and client outcomes.
• Build your career in an innovative healthcare technology company reshaping how third-party liability claims are found and recovered.