Cost Transparency Specialist

Who are we? Yuzu is a tech-enabled, vertically integrated Third-Party Administrator (TPA) that powers innovative health plans centered on care navigation, capitated primary care, and real-time payments. Unlike traditional TPAs, we partner closely with plan designers who serve as care navigators, contract negotiators, and sales teams for the uniquely tailored plans they create. We currently support thousands of employees and differentiate ourselves by helping new models of healthcare delivery come to life — enabling new ways to access and pay for care through health care coverage. Our goal is simple: make it easy for any business to build and manage a custom health plan. We do this by efficiently processing claims, ensuring regulatory compliance, and building technology that enables custom payment flows and seamless collaboration across stakeholders. Equally important, we provide our members with high-quality support to ensure they have the guidance and assistance they need at every step of their healthcare journey. As we continue to grow, we’re excited to welcome another talented member of the Claims team to help us maintain our standard of exceptional service and innovation. Position Overview The Cost Transparency Specialist plays a key role in ensuring accurate, timely, and compliant processing of manual submission medical claims. This position requires strong analytical skills, deep attention to detail, and a working knowledge of medical benefit categories. The ideal candidate is solution-oriented, collaborative, and committed to delivering a high-quality client experience. Key Responsibilities In this role, you will: - Process and review manual medical claims submissions with a high level of accuracy and attention to detail. - Apply knowledge of medical coding (CPT, ICD-10, HCPCS) to ensure proper adjudication and reimbursement. - Interpret plan documents and reimbursement methodologies to ensure claims are processed in accordance with benefit design. - Manage and support cash-pay workflows, including reviewing documentation and ensuring accurate and compliant processing. - Communicate professionally with external partners regarding claims status, submission requirements, and processing details. - Educate Plan Designers on claims procedures, reimbursement timelines, and required documentation. - Support care navigation processes by ensuring accurate documentation and coordination of services. - Identify, investigate, and escalate claims discrepancies or unresolved issues to ensure timely resolution. - Maintain confidentiality and adhere to HIPAA guidelines and compliance standards. - Contribute to process improvement initiatives as we scale and strengthen our Claims Operations and Support team. Qualifications - 2+ years of experience in medical claims processing or reimbursement preferred - Working knowledge of CPT, ICD-10, and HCPCS coding - Experience with manual claims workflows and explanation of benefits (EOB) review - Familiarity with self-funded health plans and employer-sponsored benefits preferred - Proficiency with computer skills Core Competencies - Empathy and professionalism when communicating with clients and partners - Strong commitment to accuracy and attention to detail - Ability to prioritize workload effectively in a fast-paced environment - Excellent written and verbal communication skills - Critical thinking and problem-solving ability - Dependability, accountability, and ownership mindset - Collaborative, team-oriented approach What Will Make You Stand Out - Experience with innovative health plan designs, including Reference-Based Pricing (RBP), cash payment models, care navigation, and employer-sponsored Direct Primary Care (DPC) - Familiarity with HIPAA, CMS, or managed care guidelines - Knowledge in ACA compliant plans - Strong understanding of reimbursement methodologies - Experience in a startup or high-growth environment - Utilization Review and Utilization Management skills - Bilingual skills (especially Spanish) Who We’re Looking For: We’re seeking a motivated, ethical, and compassionate individual who thrives in a fast-paced, detail-oriented environment and is passionate about delivering fair and accurate outcomes. If you’re passionate about doing the right thing and bringing integrity to every claim, we’d love to hear from you. Why Join Us: - Equity opportunities - Competitive Salary - $65k in annual salary - Health benefits - 401K with Employer matching - Career growth and development opportunities - Remote capabilities - We are a high-trust team with radically high transparency and autonomy Our Interview Process: If you’re selected for an interview, here’s what you can expect: - Initial 30–45 minute video conversation with Claims Operations Leadership - Follow-up conversation with members of the broader Operations Leadership team - Take-home assignment (approx. 2 hours) designed to reflect real on-the-job work - Reference checks with 1–2 individuals you provide