Claim adjuster Jobs in Vallejo, CA

Mercor is working with a leading AI research lab to improve the capabilities of next-generation AI systems. We are seeking experienced Insurance Verification and Eligibility & Benefits Managers to evaluate AI tools designed to automate front-end revenue cycle operations. Your deep expertise in payer systems, EDI transactions, and eligibility workflows will directly inform AI models that drive accuracy and efficiency in insurance verification processes. **Responsibilities** - Oversee insurance verification, eligibility determination, and benefits investigation workflows across commercial, Medicare, Medicaid, and managed care payers. - Verify patient insurance coverage using payer portals, clearinghouses, and EDI 270/271 real-time eligibility transactions. - Identify and resolve coordination of benefits issues, coverage gaps, and eligibility discrepancies prior to service delivery. - Evaluate and annotate AI-generated eligibility verification outputs for accuracy, completeness, and payer compliance. - Develop and document SOPs for eligibility and benefits verification workflows. - Monitor KPIs including verification accuracy rates, front-end denial rates related to eligibility, and turnaround times. - Ensure compliance with payer-specific requirements, CMS guidelines, and HIPAA regulations. - Identify process gaps and recommend workflow improvements to reduce eligibility-related claim denials. - Provide structured feedback and annotations to support AI training datasets. **Requirements** - 5+ years of experience in insurance verification, eligibility and benefits management, or front-end revenue cycle operations, with at least 2 years in a management role. - Expert knowledge of EDI 270/271 transactions, payer portal navigation, and real-time eligibility tools. - Strong familiarity with Medicare, Medicaid, and commercial payer eligibility requirements and benefit structures. - Proficiency with Epic, Cerner, Meditech, or equivalent EHR platforms. - Experience with clearinghouse platforms such as Availity, Change Healthcare, or similar. - Exceptional written and verbal English communication skills. - High attention to detail with the ability to identify subtle discrepancies in coverage data. **Preferred Qualifications** - CHAM, CHAA, or equivalent front-end revenue cycle certification. - Experience with automated eligibility verification tools and RPA solutions. - Background in denial root cause analysis related to eligibility and coverage errors. - Familiarity with AI tools and comfort evaluating AI-generated healthcare content. - Experience presenting eligibility performance data to senior leadership. **Why Join?** - Contribute to the development of frontier AI systems in healthcare. - Collaborate with a world-class AI research organisation. - Gain exposure to cutting-edge AI workflows in healthcare revenue cycle management. - Opportunity to work on high-impact projects shaping the future of healthcare AI.