Technical Analyst - Claims Automation

About the role

We’re looking for a Technical Analyst focused on Claims Automation to join our configuration team. In this role, you will drive auto-adjudication and workflow optimization by identifying manual claim scenarios and designing systemic solutions. You will partner closely with engineering, vendors, and internal teams to expand automated capabilities, increase efficiency, and lower cost per claim.

Responsibilities

• Identify high-volume manual claim scenarios and evaluate opportunities for automation
• Design and implement automation enhancements within the claims processing system
• Partner with engineering and vendors, including Mphasis, to expand systemic and auto-adjudication capabilities
• Analyze claims workflows and system logic to identify inefficiencies and recommend improvements
• Translate business requirements into technical solutions aligned with claims processing standards
• Document automation workflows, business rules, and system configurations
• Monitor auto-adjudication performance metrics and identify opportunities to improve turnaround time and accuracy
• Support testing and validation of system changes and automation enhancements
• Demonstrate commitment to our core competencies of being authentic, curious, creative, empathetic, and outcome oriented
• Support EDI workflows and troubleshoot transaction issues including 837 claim submissions and 835 remittance files in partnership with the EDI team

Requirements

• 3+ years of experience in claims systems, business analysis, or healthcare IT
• Understanding of claims adjudication processes and system workflow logic
• Working knowledge of SQL or similar tools for analyzing data and system performance
• Experience identifying and implementing process automation or system enhancements
• Ability to translate complex business problems into technical requirements
• Strong analytical and problem-solving skills with attention to detail
• Experience working cross-functionally with engineering, operations, and vendor partners

Skills

• Familiarity with Javelina or similar claims processing platforms
• Working knowledge of EDI formats (837/835) and medical coding systems
• Experience with vendor management and SLA monitoring
• Previous startup or high-growth company experience

Benefits

• Standard health and wellness benefits
• Alternative medicine coverage
• Flexible PTO
• Up to 16 weeks paid parental leave
• Paid holidays
• 401k program
• Transportation perks
• Education reimbursement
• 2 days of paid paw-ternity leave

Pay

Compensation Range: $66,975 - $89,300