Senior Claims Reviewer

Arlo is rebuilding health insurance from the ground up using AI. The healthcare experience today is expensive, confusing, and often so frustrating that people delay the care they need. We’re changing that by reimagining what a health plan should be: a proactive partner that enables health rather than denying it. Our AI-native platform delivers continuous, personalized support for members—helping them navigate benefits, schedule appointments, access high-quality care, and avoid financial fear. Powered by the industry’s most advanced risk-pricing engine, Arlo is already scaling fast: we’ve grown to $XXXM in premiums, cover tens of thousands of people, and see accelerating demand across brokers, employers, and partners. Backed by Upfront Ventures, 8VC, and General Catalyst, our team combines deep industry expertise (Palantir, YC) with the ambition to modernize a $1T market.

About the Role

Arlo is hiring for an experienced Claims Reviewer to join our stop-loss and medical claims operations team. This role is responsible for reviewing aggregate claims as well as high-cost and complex claims, ensuring accurate adjudication, and identifying opportunities for cost containment and fraud prevention. You will play a critical part in protecting Arlo’s clients and ensuring every claim is processed accurately, efficiently, and in line with plan provisions.

What You Will Do

• Review stop-loss and large medical claims for accuracy, completeness, and compliance with plan terms.

• Adjust and re-adjudicate claims where errors, inappropriate billing, or overpayments are identified.

• Investigate potentially fraudulent or wasteful claims by analyzing billing patterns, provider behavior, and coding anomalies.

• Collaborate with cost containment partners, networks, and TPAs to validate billed charges and recover overpayments.

• Use data and reporting tools to spot trends, anomalies, and emerging risk areas in claims submissions.

• Provide detailed documentation and recommendations for denials, reimbursements, or escalations.

• Support process improvement initiatives and help refine Arlo’s claims review and cost containment protocols.

What We Are Looking For

• 5+ years of experience in medical or stop-loss claims review, audit, or adjudication

• Meticulous, analytical, and detail-oriented — you take pride in accuracy and root-cause thinking

• Experienced in identifying inappropriate billing, duplicate charges, and coding errors (ICD-10, CPT, HCPCS, DRG)

• Comfortable communicating with TPAs, providers, and internal stakeholders to resolve discrepancies

• In-depth understanding of plan design, coordination of benefits, subrogation, and provider billing practices

• Familiarity with fraud, waste, and abuse (FWA) detection

• Strong working knowledge of claims processing systems and supporting tools (Excel, SQL, Python)

• Bachelor’s degree or equivalent experience in healthcare administration, insurance, or a related field.

Process

This is what you can expect when we like your application:

• 30 minute conversation with Rachelle (Talent Lead)

• 45-min call with Karthik (CTO and Co-Founder)

• Take-home case study

• Onsite/ Virtual Onsite

• Reference Calls

Compensation

$75,000 – $90,000

Why Join Arlo:

• High ownership: You’ll get real responsibility from day one—our high-trust team empowers you to run with big problems and shape core parts of the company.

• Join an important mission: Your work directly influences how people access care and improves lives at scale.

• Growth & expansion: We’re moving fast, and as we grow, your scope will grow with us—new challenges, bigger opportunities, and rapid career velocity.

• Apply AI to a problem that matters: Instead of optimizing ads or cutting labor costs, you’ll use AI to fundamentally reimagine how people get healthcare.

• High pace, high collaboration: We operate with velocity, first-principles thinking, and a team that works closely, openly, and with ambition.

Exact compensation inclusive of salary and any bonuses is determined based on a number of factors including experience and skill level, location, and qualifications which are assessed during the interview process.

Arlo is an equal opportunity employer. We do not discriminate based on age, race, color, creed or religion, national origin, sexual orientation, gender identity or expression, military status, sex, disability, predisposing genetic characteristics, marital status, familial status, status as a victim of domestic violence, or arrest or conviction record, as defined under New York State law.