Clinical Subject Matter Expert

About the Role

We're looking for a Clinical Subject Matter Expert to own the clinical judgment behind our position statements as we take on more complex facility claims. You'll work side by side with Product and Engineering and shape how our model learns what a persuasive, defensible argument looks like. This role reports directly to our Product Lead.

The work is hands-on. You'll read the position statements our model drafts, decide what a reviewer would accept or reject, and turn those calls into annotations, evaluation criteria, and clear requirements for the team. You'll also work out what clinical and billing context we need to gather for each claim, so the statement can describe the care delivered and defend our offer.

This is an embedded role, not a consulting engagement. You'll sit inside Product, and your expertise will show up in the product every day. If you've spent your career in denials and appeals and want to see that judgment built into software that does the work at scale, this is a great seat.

What You’ll Do

• Review position statements: Read the statements our model drafts for facility claims, judge what a reviewer would find credible, and flag where the clinical reasoning is thin or the services provided are described poorly.

• Own the clinical standard for a strong statement: Define what good looks like for describing the care delivered and defending our offer, and turn it into guidance Product and Engineering can build against.

• Annotate to train the model: Label and annotate statements consistently so the model keeps learning from expert judgment, and track how quality changes over time.

• Build and run evaluations: Design the criteria and test sets we use to measure statement quality, run them as the model and templates change, and report what moved.

• Define what context we gather: Work out which clinical and billing details we need for each claim type, and write clear requirements for how Product collects and uses them.

• Partner with Product and Engineering: Join planning and reviews as the clinical voice, answer questions quickly, and keep decisions grounded in how denials and appeals actually work.

• Bring in feedback from the field: Take what reviewers and our operations and client-facing teams tell us about why statements win or lose, and turn recurring patterns into product improvements.

• Extend your expertise across facility claims: Help the team understand the coding, billing, and reimbursement nuances on the facility side, such as bundled charges and billing code sourcing, so requirements reflect reality.

Who You Are

• A clinical background, most often nursing, with 5+ years of experience in clinical documentation, denials, or appeals

• Hands-on experience writing or reviewing appeals, denial responses, or clinical arguments meant to persuade a payer, with specific outcomes you can walk us through

• Working knowledge of facility billing, coding, and reimbursement, including how claims, charges, and codes fit together

• Experience giving structured, consistent feedback on written work, such as annotating or scoring drafts against a rubric

• The ability to turn clinical judgment into clear written requirements and criteria that engineers and product managers can act on

• Comfort working inside a product team where processes are still being built, ideally at a startup or technology company

• Curiosity about how AI models learn and where they go wrong, and the directness to tell a team when a statement isn't good enough and why

Extra Credit if you have:

• Experience in revenue integrity, utilization review, or clinical documentation improvement for hospitals or health systems

• Familiarity with the No Surprises Act or Independent Dispute Resolution

• Experience working with 835/837 claims data or evaluating AI-generated content

Benefits Include:

• Competitive compensation, including equity

• Full health, dental, and vision coverage

• Retirement savings plan through 401(k)

• Flexible time off

• Opportunities for company-wide connection and events

Employment Information