Healthcare Founder, Claims Intelligence
full-time•United States
About this role
CMS just turned on the data. No one's using it yet.
TPAs have been auditing claims after costs lock in. CMS price transparency mandates changed that. Machine-readable pricing files now exist. You can see costs before adjudication and intervene in real-time.
Influence 5-10% of claims pre-adjudication, drive millions in value.
Why now: CMS Prior Authorization rule (Jan 2026), FHIR APIs mandated, price transparency files live. Infrastructure just went online.
The play: Start with pre-adjudication intelligence. Expand to post-claim repricing, denials, appeals. Build toward an AI-native TPA that charges on outcomes, not percentage of claims.
We're looking for Founders with deep experience in claims adjudication, TPA operations, or healthcare pricing. You know how TPAs make money, what drives their costs, and where intervention creates value. You also understand the technical layer - what's in machine-readable files, how FHIR APIs work, how claims flow through adjudication.
Your Partners in Co-Creation:
Forum's AI Studio brings together ambitious people, brilliant ideas, and capital to build the best B2B SaaS businesses in the world, from 0 to 1. In addition to capital and an idea, we provide founders with access to investor networks, fundraising support, and the resources needed to build transformational companies. We've launched 17 companies since 2023, and we're launching 7 more in 2026. We're designed to help Founders move faster, develop better insights, and build companies that have a higher success rate than startups built in any other way.
Forum derisks and accelerates the Founder path by:
A $250K USD investment, and an end-to-end fundraising playbook and network to raise your seed and Series A
A validation partner with proven playbooks, networks, and the systems to validate, unlock your ICP, ignite your sales pipeline, and beyond
The support of our experienced operating team - from business design, product development, growth, recruitment, legal and more
Executing a winning GTM strategy to get to $50-100K ARR, and the right MVP to ensure early traction
A community full of mentors, peers, and leaders
$100K worth of business perks
About you:
Domain expertise, plus you've been through the messy middle as a founder or early operator
You can attract, hire, and lead strong teams
You believe technology can change the world
You want to be a venture-backed founder
Canada or US-based, able to work in North American time zones
Please note, this is not an employment opportunity with Forum Ventures. If you are currently fundraising your pre-seed or Seed round, please pitch our investment team instead here.
What you'll do
- The role involves influencing claims pre-adjudication and driving value through real-time interventions. The founder will also expand into post-claim repricing, denials, and appeals.
About Forum Ventures
Forum Ventures is the leading early-stage fund, program and community for B2B SaaS startups. Founded in 2014 as Acceleprise, we’re on a mission to make the B2B SaaS journey easier, more accessible and successful for early-stage founders, through funding, high touch programming, corporate perks and introductions, and an active SaaS community.
Forum For Founders, our pre-seed program, provides founders with $100k in funding and 15 intense weeks of talks, events, mentorship and 1:1 guidance focused on go to market and fundraising. Forum Seed, our seed fund, backs exceptional SaaS startups at the seed-stage both from within and outside of our pre-seed program.
With over 400 portfolio companies, Forum founders have gone on to raise ~$1B in follow-on funding from NEA, Andreessen Horowitz, Uncork Capital, 8VC, Founders Fund, Menlo Ventures, Canaan, Bowery Capital, Susa Ventures, Salesforce Ventures, SV Angel, True Ventures and many more.
Learn more at www.forumvc.com
Looking for more founder-focused advice? Subscribe to The Midnight Text -- a bi-weekly newsletter that provides honest answers to the unspoken questions that keep founders awake at (mid)night. https://midnighttext.substack.com/
Ready to join Forum Ventures?
Take the next step in your career journey
Frequently Asked Questions
What does a Healthcare Founder, Claims Intelligence do at Forum Ventures?
As a Healthcare Founder, Claims Intelligence at Forum Ventures, you will: the role involves influencing claims pre-adjudication and driving value through real-time interventions. The founder will also expand into post-claim repricing, denials, and appeals..
Is the Healthcare Founder, Claims Intelligence position at Forum Ventures remote?
The Healthcare Founder, Claims Intelligence position at Forum Ventures is based in United States, United States. Contact the company through Clera for specific work arrangement details.
How do I apply for the Healthcare Founder, Claims Intelligence position at Forum Ventures?
You can apply for the Healthcare Founder, Claims Intelligence position at Forum Venturesdirectly through Clera. Click the "Apply Now" button above to start your application. Clera's AI-powered platform will help match your profile with this opportunity and guide you through the application process.