About CoverSelf

CoverSelf empowers US healthcare payers with a truly next-generation, cloud-native, holistic, and customizable platform designed to prevent and adapt to the ever-evolving inaccuracies in healthcare claims and payments. By reducing complexity and administrative costs, we offer a unified, healthcare-dedicated platform backed by top VCs like BeeNext, 3One4 Capital, and Z21 Ventures.

Position Overview

This role focuses on developing clinical content, payment integrity rules, and code edit solutions. The Clinical Content Specialist will translate clinical guidelines and payer policies into business logic, algorithms, and rule frameworks for automated claims validation.

Specialty Expertise

Payment Integrity

Clinical Coding & Policy Development

Claims Prepayment Review

Data Mining & Content Development

Key Responsibilities

Develop and maintain payment integrity rules, edits, and policie

Design clinical logic & algorithms for claims validation

Translate CMS guidelines → business rules

Build code edit solutions to detect incorrect payments





Conduct research on medical policies and reimbursement methodologies

Enhance and maintain policy libraries and rule frameworks

Support semi-automated claims review systems

Requirements

Robust experience in Payment Integrity / Clinical Content / Policy building

Ability to convert clinical guidelines into logical rules

Knowledge of CMS policies, payer guidelines, and coding standards

Solid analytical and problem-solving mindset

• Solid understanding of medical coding & billing methodologies and guidelines, including CPT, ICD, LCD/NCD, PTP, NCCI, edits, modifiers, Medicare Physician fee schedule, and coding conventions.
• Proficiency in data collection, analysis, and deriving actionable insights from CMS medical policies, Medicaid Provider Manuals and other Medical publications.
• Translate industry references into actionable business logic to support new rules and policy enhancements.
• Solid understan

📌 Clinical Content Specialist Bengaluru
🏢 CoverSelf
📍 Bengaluru