Claim examiner Jobs in Lancaster, CA

Mercor is working with a leading AI research lab to improve the capabilities of next-generation AI systems. We are seeking experienced Underpayment and Managed Care Contract Specialists to evaluate AI tools designed to detect payment variances and automate contract compliance monitoring. Your expertise in payer contract interpretation, payment variance analysis, and underpayment recovery will help AI systems optimise net revenue and identify systematic underpayments. **Responsibilities** - Identify, analyse, and recover underpayments and payment variances across commercial, Medicare Advantage, and Medicaid managed care payer contracts. - Evaluate AI-generated underpayment detection alerts, contract compliance outputs, and payment variance analyses for accuracy. - Interpret payer contract terms including fee schedules, carve-outs, outlier provisions, and payment methodologies to validate claim payments. - Conduct contract modelling and payment reconciliation to identify systematic underpayment patterns. - Develop and submit underpayment claims and recovery correspondence to payers. - Collaborate with managed care contracting teams to identify contract language gaps and renegotiation opportunities. - Monitor underpayment recovery KPIs including identified underpayment dollars, recovery rates, and payer response rates. - Ensure compliance with payer contract terms, HIPAA, and timely filing requirements for underpayment recovery. - Annotate AI outputs and provide structured feedback to support AI training datasets. **Requirements** - 5+ years of experience in underpayment recovery, payment variance analysis, or managed care contracting, with demonstrated expertise in contract interpretation. - Deep knowledge of payer payment methodologies including DRG-based, per diem, per cent-of-billed charges, and fee schedule reimbursement. - Strong experience with contract modelling, payment reconciliation, and payer dispute resolution. - Familiarity with managed care contract management systems and payment variance detection tools. - Proficiency with Excel-based financial analysis and revenue cycle analytics platforms. - Exceptional written and verbal English communication skills. - High attention to detail with the ability to identify payment discrepancies in complex contract structures and AI-generated outputs. **Preferred Qualifications** - CHFP, CRCR, or managed care contracting certification. - Experience with contract management software (e.g., Experian Health, Recondo, or similar). - Background in hospital, health system, or large physician group underpayment recovery operations. - Familiarity with AI tools and comfort evaluating AI-generated payment variance content. - Experience negotiating payer contracts and presenting underpayment analysis to executive 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 managed care contracting and the revenue cycle. - Opportunity to work on high-impact projects shaping the future of healthcare AI.