Claim examiner Jobs in Temecula, CA

Mercor is working with a leading AI research lab to improve the capabilities of next-generation AI systems. We are seeking experienced A/R Follow-Up Managers to evaluate AI tools designed to automate accounts receivable follow-up and payer collections workflows. Your expertise in claim status follow-up, payer correspondence, and A/R management will directly inform AI systems that reduce days in accounts receivable and improve revenue recovery. **Responsibilities** - Lead A/R follow-up operations across commercial, Medicare, Medicaid, and managed care payers, ensuring timely resolution of outstanding claims. - Evaluate AI-generated A/R follow-up recommendations, claim status inquiry outputs, and payer correspondence drafts for accuracy and effectiveness. - Manage claim status follow-up workflows including electronic claim status inquiries (276/277 EDI), payer portal follow-up, and phone-based resolution. - Prioritise A/R queues by ageing bucket, payer, and dollar value to maximise revenue recovery. - Identify and resolve claim payment discrepancies, payer processing errors, and underpayments. - Monitor A/R KPIs including days in A/R, ageing bucket distribution, collection rates, and write-off rates. - Develop and implement payer-specific follow-up strategies to accelerate claim resolution. - Ensure compliance with FDCPA, HIPAA, and payer-specific follow-up and timely filing requirements. - Annotate AI outputs and provide structured feedback to support AI training datasets. **Requirements** - 5+ years of experience in A/R follow-up, payer collections, or revenue cycle operations, with at least 2 years in a management role. - Deep knowledge of claim status follow-up workflows, EDI 276/277 transactions, and payer-specific collections processes. - Strong understanding of Medicare, Medicaid, and commercial payer claims processing and payment timelines. - Experience prioritising and managing high-volume A/R queues across multiple payers. - Proficiency with billing systems and A/R management platforms. - Exceptional written and verbal English communication skills. - High attention to detail with the ability to identify payment errors and discrepancies in AI-generated A/R content. **Preferred Qualifications** - CRCR, CPC, or CHFP certification. - Experience with RCM technology platforms featuring automated A/R follow-up capabilities. - Background in multi-payer follow-up operations in hospital or physician group settings. - Familiarity with AI tools and comfort evaluating AI-generated A/R follow-up content. - Experience developing A/R reduction action plans and presenting performance to 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 accounts receivable and revenue cycle management. - Opportunity to work on high-impact projects shaping the future of healthcare AI.