Judi Health
Lead, Medical Network Claims Pricer
$107K–$160K
Charlotte, North Carolina, United States +5 · Full-time · Posted Aug 12, 2026
- Location
- Charlotte, North Carolina, United States
Denver, Colorado, United States
New York, New York, United States
Charlotte, North Carolina, United States
Denver, Colorado, United States
New York, New York, United States - Experience
- Seven or more years of progressive experience in medical claim pricing, provider reimbursement, medical claims analysis, payment integrity, managed-care pricing, or a closely related function, including direct responsibility for complex manual claim calculations.
- Education
- Bachelor’s degree in finance, economics, business, healthcare administration, health information management, data analytics, mathematics, information systems, or a related field required.
About the job
Leads medical claim pricing by interpreting reimbursement terms, calculating and validating claim payments, maintaining pricing data, resolving exceptions, and translating pricing workflows into automated platform requirements.
What you'll do
- Manually price complex medical claims and document reimbursement rules, calculations, and assumptions.
- Prepare and maintain reimbursement data; investigate pricing exceptions and reconcile outcomes.
- Partner with Product and Engineering on automation requirements, testing, quality controls, and platform improvements.
What they ask for
- Bachelor’s degree in a related field.
- Subject matter expertise in Medicare-based reimbursement, Reference-Based Pricing, claim pricing, fee schedules, and healthcare payment methodologies.
- Advanced knowledge of medical coding and reimbursement methods; demonstrated ability to calculate allowed amounts and document decisions clearly.
- Advanced Microsoft Excel and large-data analysis skills; experience preparing reimbursement data for system ingestion and converting workflows into technical requirements.
Nice to have
- Experience in a health plan, third-party administrator, healthcare technology organization, provider network, or medical claims platform.
- Experience with government programs, provider network negotiations, or Agile product development; relevant graduate degree or certification.
Pay
$128,000 — $160,000 USD (base salary); $117,600 — $147,600 USD (base salary); $106,800 — $133,500 USD (base salary)
Tools
Microsoft Excel, SQL
Model-written summary · the original posting is authoritative