Hiring: Payer Policy Specialist – Healthcare AI Evaluation Project

We are looking for an experienced Payer Policy Specialist to support a short-term Healthcare AI Evaluation Project.

Role: Payer Policy Specialist

Experience: 3+ years

Work Mode: Remote

Key Responsibilities

Review and evaluate healthcare payer policies, coverage criteria, and medical guidelines.
Analyze payer policies to determine coverage, eligibility, and medical necessity requirements.
Validate policy information against relevant source documents and guidelines.
Identify discrepancies, gaps, or inconsistencies in policy interpretation.
Review and assess clinical and administrative criteria used in payer decision-making.
Provide accurate documentation and feedback to support the evaluation process.

Requirements

3+ years of experience in payer policy, health insurance, utilization management, medical review, or a related healthcare field.
Strong understanding of health insurance policies, coverage criteria, and medical necessity guidelines.
Experience reviewing and interpreting payer policies and clinical documentation.
Strong analytical and research skills with excellent attention to detail.
Ability to work with structured documentation and evaluate information against defined criteria.
Experience with healthcare QA, medical policy review, or healthcare AI evaluation will be an advantage.

Interested

Please share your updated resume via LinkedIn message, along with a brief summary of your relevant payer policy/healthcare experience.

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Payer policy specialist