Claims Resolution 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.

The Role:

As a Claims Resolution Specialist, you will be a key member of our growing Claims Operations Department, committed to delivering exceptional service and accurate outcomes.

In this role, you will:

• Process claims in alignment with implemented plan designs

• Assist the Customer Support team by responding to inquiries, supporting complex case resolution, and handling phone calls as needed

• Uphold high standards for precision, accuracy, and attention to detail in every claim you handle

• Proactively identify and communicate risks and opportunities within our claims processes

• Help prepare and track stop loss filings to ensure continuous and timely claims payments

• Play a critical role in evolving and strengthening our Claims Operations team as we scale and take on new challenges

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.

Ideal Candidates Would Possess:

• Experience in healthcare claims processing, preferably within a mid-sized TPA operating in the self-funded space

• A strong commitment to accuracy and attention to detail

• The ability to prioritize workload effectively in a fast-paced environment

• Strong communication skills

What Will Make You Stand Out:

• Experience with innovative health insurance plan designs, including Reference-Based Pricing (RBP), cash payment models, and employer-sponsored Direct Primary Care

Why Join Us:

• Equity opportunities

• Competitive Salary

  • Approximately $48-$60k in annual salary depending on experience, location, and desired equity

• 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

• Possible onsite visit to our NYC office, depending on your location and role expectations