Point C

General

• Resolve second-level escalations beyond first-line CSR capability across claims, eligibility, benefits, and billing inquiries
• Investigate issues thoroughly, document findings, and record all activity in the centralized escalation tracker
• Determine root cause where possible; when the issue is an education matter, work directly with the member to provide education
• Assist in escalated call audits and tracking currently being done by the Customer Service Director
• Escalate to an ESR when an issue is technically complex or requires deeper expertise, providing a clear and documented handoff
• Take approved immediate actions within authority and route “send-on” items to the appropriate team
• Meet acknowledgment, response, and resolution SLAs based on issue severity
• Coordinate all client-facing responses through Account Management and the RRT; avoid conflicting or untracked communication
• Flag recurring issues and emerging patterns to the RRT to support trend identification and root cause analysis

Service Resolution Specialist

Claims Specialist

• Adjudicate new claims and process adjustments, including denials upon receipt of additional information
• Review and resolve appeals and subrogation/third-party liability cases
• Manage individual inventory to ensure timely turnaround and production goals are met
• Ensure claims are processed in accordance with stop loss contract terms
• Respond to internal and external inquiries via email and other channels within established timeframes
• Follow up on missing or incomplete information to ensure claims can be accurately processed
• Maintain minimum production, financial, and procedural accuracy standards on a monthly basis

Claims Examiner

Product Manager

• Own the Zendesk platform roadmap end-to-end; from initial configuration through future enhancements and builds, prioritizing improvements that align with business needs and stakeholder goals
• Lead the configuration and administration of Zendesk, including fields, workflows, views, triggers, automations, dashboards, and reporting
• Leverage AI capabilities within Zendesk to enhance ticket routing, automate workflows, and improve overall operational efficiency
• Gather requirements from business stakeholders, translate them into functional enhancements within the platform, and manage the backlog of system improvements
• Proactively identify opportunities to improve Zendesk workflows, UI, and usability and proposing solutions
• Partner with Claims, Client Services, Account Management, and IT teams as primary stakeholders, gathering sign-offs and ensuring Zendesk configuration meets the needs of each user group
• Support a multi-phase enterprise rollout of Zendesk, coordinating with IT as the platform transitions and expands organization-wide
• Manage user roles, permissions, access controls, and data integrity, ensuring governance standards are maintained as the platform scales
• Support integrations between Zendesk and internal systems; coordinate testing and deployment of system updates and new builds
• Communicate roadmap priorities, system updates, and change management needs to stakeholders at all levels, including leadership sign-off and team-level rollout support
• Manage vendor relationships and support cost management and augmentation decisions related to Zendesk
• Partner with the training and management team to create documentation, lead onboarding sessions, and promote best practices across all user teams
• Provide ongoing end-user support and troubleshooting, serving as the internal subject matter expert for Zendesk across the organization

Product Owner – Configuration Administrator

Business Intelligence Developer

• Design, build, and maintain Power BI reports and dashboards supporting healthcare, financial, and operational analytics.
• Develop and optimize semantic models, relationships, measures, and calculated columns.
• Create and maintain complex DAX measures aligned to healthcare KPIs such as utilization, claims, eligibility, quality, and financial performance.
• Partner with business and clinical stakeholders to translate requirements into clear, actionable analytics.
• Ensure BI solutions follow best practices for performance, scalability, usability, and security.
• Administer the Power BI Service, including workspace configuration, security, dataset refreshes, user access, and row-level security.
• Monitor report and dataset performance and resolve refresh, gateway, and licensing issues.
• Establish and maintain Power BI standards, documentation, and governance practices.
• Support deployments across development, test, and production environments.
• Perform other duties as assigned in support of analytics and business initiatives.

Senior Power BI Developer

Operations

• Own the end-to-end claims funding process, including check register generation, Echo file transmissions, EOB template management, and custodial account reconciliation across all client groups
• Lead and develop a team of funding specialists; assign group portfolios, establish daily workflows, and ensure accuracy, timeliness, and compliance
• Drive the implementation and operationalization of check run automation within the VBA platform; serve as the internal subject matter expert
• Establish and monitor KPIs, SLAs, and quality controls for all funding operations; reduce error rates and client escalations
• Manage vendor relationships, including ECHO Health, for file transmissions and troubleshooting
• Partner with IT on system issues, automation enhancements, and platform migrations
• Develop and maintain SOPs, staffing models, and training materials for the funding team
• Support acquisition integrations and the consolidation of funding processes onto a unified platform
• Serve as the Finance liaison for all funding-related client inquiries, stop loss coordination, and claims register reviews

Payment Operations Manager

Representative

• Serve as a primary contact for assigned employer groups regarding benefits administration and service inquiries
• Respond to employer, broker, and member requests via phone, email, and ticketing systems within established service standards
• Educate employer groups on TPA processes, policies, eligibility rules, and available services
• Build and maintain positive working relationships with clients and brokers
• Coordinate with claims, provider relations, and stop-loss departments to resolve escalated issues
• Research claim status inquiries and facilitate timely resolutions
• Track and document service issues to ensure follow-through and client satisfaction
• Maintain confidentiality and ensure compliance with HIPAA and company policies
• Document client interactions and account activity accurately within internal systems
• Support audit requests and reporting needs as required
• Participate in employer implementations and renewals
• Identify opportunities for process improvement and enhanced client experience
• Support special projects and cross-functional initiatives as assigned

Employer Service Representative

Data Scientist

• Partner with operational leaders to identify high-friction, high-volume manual workflows and opportunities to automate and improve processes using AI and data science across claims, plan administration, client services, and clinical/UM functions
• Design and build AI-assisted tools and prototype solutions using Anthropic’s Claude platform – from prompt-based assistants to lightweight internal apps; focus is on initial concepts and working prototypes, not full-scale production builds
• Prototype quickly; target concept-to-working-demo timelines of days, not weeks; partner with engineers and technical team members to hand off and build out solutions beyond the prototype stage
• Collaborate with the AI & Automation Engineering team on solutions requiring API integrations or multi-system workflows
• Document use cases, build logic, and outcomes so solutions are repeatable beyond the internship; write clear documentation capturing the idea, logic, and intended approach for each solution to enable handoff and continuity
• Present findings and ROI framing to operational and executive leadership
• Help build and deliver an AI Efficiency Playbook at the close of the internship – capturing what was built, what it replaced, recommended next steps, and a framework for how Point C can continue identifying and implementing AI-driven improvements

Data Science AI Intern

Artificial Intelligence

• Partner with clinical and utilization management teams to understand workflows, data needs, and areas where analysis can improve decision-making and outcomes
• Use AI tools to accelerate data pulls and surface patterns across large clinical datasets
• Analyze AI findings to flag trends or anomalies that may not be immediately visible through manual review
• Leverage AI to support documentation tasks such as drafting summaries, structuring findings, and generating repeatable templates for clinical and operational use
• Pull, clean, and analyze healthcare data including claims, date of service, provider specialty, utilization patterns, and clinical indicators
• Identify trends and draw actionable insights from clinical and utilization data to support care management, cost containment, and quality improvement efforts
• Support the clinical team in understanding benefit structures, plan designs, and how they interact with utilization and outcomes data
• Identify opportunities where AI or automation could streamline clinical review processes, flag outliers, or reduce manual workload for clinical staff
• Build lightweight data tools, dashboards, or summary reports to make clinical and utilization data more accessible and actionable
• Document findings, methodologies, and recommendations clearly so insights are repeatable and usable beyond the internship
• Present data findings and recommendations to clinical and operational leadership in a clear, accessible format

Healthcare Informatics AI Intern

Account Manager

• Support Account Managers in day-to-day client and broker relationship management, serving as a professional point of contact when needed
• Utilize AI tools to accelerate research and create more efficient processes
• Use AI to research client needs and industry trends to support account strategy and client conversations
• Incorporate AI tools into drafting and refining client communications to produce polished deliverables more effectively
• Prepare and assemble client-facing documents including presentations, slide decks, letters, summaries, and renewal materials
• Draft professional correspondence and communications on behalf of clients and the account management team
• Assist in organizing and preparing for client and broker meetings, including agenda development, materials preparation, and follow-up documentation
• Maintain accurate client records, track open items, and support follow-through on account management deliverables
• Represent Point C professionally in all written, verbal, and visual communications with a high standard for quality and presentation

Account Management AI Intern

• Serve as a key support for clients in partnership with Client Services team members to support business retention.
• Provide administrative support to the Client Services team to ensure successful delivery of client service commitments.
• Prepare and run client-specific reports as needed to support account management activities.
• Collaborate with internal Point C teams and TPA partners to research and respond to client inquiries in a timely manner.
• Facilitate the resolution of client concerns by coordinating across departments and ensuring follow-up.
• Participate in client-facing activities such as benefit fairs, employee meetings, and enrollment presentations.

Account Specialist

Full-stack Engineer

• Build and maintain full-stack Azure-hosted portals (internal member portal, external client portal, Argus portal) across UI, API, and data layers
• Contribute to the Argus EDI platform, handling healthcare transactions including eligibility, claims, remittance, and acknowledgments
• Develop and extend CRM functionality supporting TPA operations and client management
• Work with Azure services (App Services, Azure SQL, Functions, Storage, AI Services) and participate in architectural decisions
• Integrate AI/automation capabilities into products and workflows; use tools like GitHub Copilot and Azure AI as part of your daily development process
• Collaborate with stakeholders across multiple TPA entities to understand requirements and deliver solutions

Software Engineer – Contractor

• Design, develop, and deliver virtual training programs for new and existing staff across Operations.
• Train employees using established claims systems, processes, and procedural documentation.
• Inspire, coach, and motivate employees to achieve performance and quality goals.
• Identify training needs and develop appropriate curriculum and learning tools.
• Communicate training progress and outcomes to leadership in a timely and clear manner.
• Create and maintain training materials, including handouts, guides, and job aids.
• Conduct training needs assessments and operational audits to identify opportunities for development.
• Collaborate with operational teams to draft, revise, and certify organizational policies and procedures.
• Integrate procedural updates into training programs on an ongoing basis.
• Lead ongoing training initiatives related to system releases, new clients, or process improvements.
• Demonstrate strong presentation skills and a customer-service-oriented approach.

Operations Trainer

Customer Support

• Collaborate closely with the sales team to support and execute stop loss marketing strategies.
• Analyze and scrub client data to prepare comprehensive and accurate marketing requests.
• Act as a liaison between stop loss carriers and the sales team, ensuring smooth communication and efficient exchange of information.
• Submit and track network reporting requests with accuracy and timeliness.
• Manage workflows and deadlines across multiple concurrent projects—organization and attention to detail are essential.
• Foster teamwork and collaboration by being a reliable, communicative, and solutions-oriented partner within a cross-functional environment.