Medical/Financial Risk Evaluation Professional

Job Description

• This position is posted by Jobgether on behalf of a partner company. We are currently looking for a Medical/Financial Risk Evaluation Professional in the United States. This role plays a critical part in identifying, assessing, and mitigating medical and financial risks within complex healthcare and claims environments. You will work at the intersection of data, operations, and compliance, ensuring that risks arising from processes, systems, or external factors are properly evaluated and addressed. The position requires strong analytical thinking and the ability to operate independently while navigating ambiguous or evolving situations. You will collaborate with cross-functional stakeholders to support risk-informed decision-making and maintain operational integrity. This is a detail-oriented, metrics-driven role where accuracy, consistency, and critical judgment directly impact financial outcomes and organizational performance. The environment is collaborative yet autonomous, offering exposure to large-scale healthcare data and risk frameworks. You will also contribute to continuous improvement in risk detection and mitigation processes.
• Accountabilities: Support the identification, assessment, and mitigation of medical and financial risks across claims, processes, systems, and operational workflows. Analyze claims and operational data to detect anomalies, risks, and potential financial exposure. Evaluate risk scenarios and determine appropriate mitigation strategies in alignment with established guidelines and procedures. Conduct detailed claims auditing and validation to ensure accuracy, compliance, and financial integrity. Collaborate with cross-functional teams to resolve issues and improve risk detection processes. Maintain documentation of findings, risk assessments, and corrective actions for audit and reporting purposes. Apply independent judgment to resolve moderately complex cases while escalating high-risk or ambiguous issues when needed. Contribute to process improvement initiatives aimed at reducing risk and increasing operational efficiency. Requirements: Minimum of 2 years of experience in medical claims billing, auditing, or related healthcare financial operations. Strong analytical and data interpretation skills, with experience extracting and analyzing large datasets. Proficiency in Microsoft Office tools, including Excel, PowerPoint, Access, and OneNote. Ability to work independently in a metric-driven and compliance-focused environment. Excellent written and verbal communication skills with strong attention to detail. Strong organizational skills with the ability to manage multiple priorities simultaneously. Preferred experience with SQL, claims adjudication systems (CAS), CMS/Medicare Advantage guidelines, or healthcare financial recovery processes. Background in process improvement methodologies (e.g., Six Sigma) or certification such as AAPC is a plus. Benefits: Competitive annual salary ranging from $65,000 to $88,600, depending on experience and location. Eligibility for performance-based bonus incentives. Comprehensive benefits starting on day one, including medical, dental, and vision coverage. 401(k) retirement plan with company match. Generous paid time off, including holidays, parental leave, and caregiver leave. Tuition reimbursement and ongoing professional development opportunities. Remote work arrangement with potential occasional travel for training or team meetings. Supportive environment focused on employee well-being, flexibility, and career growth.
• How Jobgether works: We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team. We appreciate your interest and wish you the best! Why Apply Through Jobgether? Data Privacy Notice: By submitting your application, you acknowledge that Jobgether will process your personal data to evaluate your candidacy and share relevant information with the hiring employer. This processing is based on legitimate interest and pre-contractual measures under applicable data protection laws (including GDPR). You may exercise your rights (access, rectification, erasure, objection) at any time. #LI-CL1
• We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If you would like more information about how your data is processed, please contact us.
• apply for this job