Senior Claims Optimizations Analyst

About the role

We're seeking a Senior Claims Optimization Analyst to join our team. This role bridges the gap between complex claims databases and enterprise scalability, focusing on automating processes and improving operational efficiency.

Responsibilities

• Independently execute deep-dive data mining across complex claims databases to identify operational friction, inefficiencies, handoff issues, and sources of waste or leakage ripe for automation.
• Design and deploy production-grade scripts (Python, R, or advanced RPA platforms) that can cross-reference multiple systems via APIs to handle bulk claims adjustments and auto-adjudication paths safely.
• Own the operational deployment and fine-tuning of generative AI and agentic workflows. Build and test the prompts that allow AI to accurately interpret claims, provider appeals, and medical records to improve cycle times.
• Monitor automated scripts and bots against upstream system updates or configuration changes, ensuring zero downtime in our automated production workflows.
• Partner cross-functionally to translate complex operational roadblocks into clean, technical requirements when partnering with core Engineering, while translating technical automation impacts into plain English for Claims leadership.
• Manage the UAT (User Acceptance Testing) process, deployment strategy, and post-launch monitoring for large-scale automation initiatives, ensuring solutions deliver the intended outcome.

Requirements

• 5+ years of progressive experience in healthcare operations analytics, process engineering, or automation delivery, with a mandatory background inside a health insurance plan or TPA.
• Advanced SQL mastery alongside deep comfort writing production-ready Python or similar scripting languages that interact with APIs and databases.
• A proven track record of successfully implementing automation frameworks and a deep interest or hands-on experience leveraging LLMs/AI to solve operational bottlenecks or extract structured information from unstructured data.
• Intimate knowledge of claims adjudication systems, claim routing logic, and how a Payment Integrity program impacts downstream provider dispute workflows.
• You don't need a blueprint. You can take a vague executive problem (e.g., "Our adjustment inventory is spiking") and independently return with a data-backed root cause and a working automation tool to fix it.

Qualifications

• Nice to have previous experience at a high growth company.

Skills

• Advanced SQL mastery
• Deep comfort writing production-ready Python or similar scripting languages that interact with APIs and databases
• Leverage LLMs/AI to solve operational bottlenecks or extract structured information from unstructured data
• Claims adjudication systems, claim routing logic, and Payment Integrity program knowledge
• Autonomy and ability to take vague problems and turn them into actionable solutions

Benefits

• Alternative medicine coverage
• Flexible PTO
• Paid parental leave
• Paid holidays
• 401k program
• Transportation perks
• Education reimbursement
• 2 days of paid paw-ternity leave

Pay

$84,450 - $112,600

Schedule

Full-time