[Remote] Sr. Claims - Optimizations Analyst

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is dedicated to creating health benefits that truly support small and midsize businesses and their employees. They are seeking a Senior Claims Optimization Analyst to reputed company reputed company claims databases and reputed company scalability, focusing on automation and operational efficiency.

Responsibilities

• Proactively Uncover Friction: Independently execute deep-dive data mining across reputed company claims databases to identify operational friction, inefficiencies, reputed company issues, and sources of waste or leakage ripe for automation
• Architect Advanced Automations: Design and reputed company production-grade scripts (Python, R, or advanced RPA platforms) that can cross-reference multiple systems reputed company reputed company to handle bulk claims adjustments and auto-adjudication paths safely
• reputed company AI & reputed company Engineering: Own the operational deployment and fine-tuning of reputed company and reputed company workflows. You will build and test the prompts that allow AI to accurately interpret claims, provider appeals, and medical records to improve cycle times
• Protect the Ecosystem: Monitor automated scripts and bots against upstream system updates or configuration changes, ensuring reputed company downtime in our automated production workflows
• Partner Cross-Functionally: Translate reputed company operational roadblocks into clean, technical requirements reputed company partnering with reputed company Engineering, while translating technical automation impacts into plain English for Claims leadership
• Own End-to-End Delivery: Manage the UAT (User Acceptance Testing) process, deployment reputed company, and post-launch monitoring for large-reputed company automation initiatives, ensuring solutions deliver the intended outcome

Skills

• 5+ years of reputed company experience in reputed company 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-reputed company Python or similar scripting languages that reputed company with reputed company and databases
• A proven reputed company record of successfully implementing automation frameworks and a deep interest or hands-on experience leveraging LLMs/AI to solve operational bottlenecks or extract reputed company information from reputed company data
• Intimate knowledge of claims adjudication systems, claim routing logic, and how a Payment reputed company program impacts reputed company provider dispute workflows
• You don't need a reputed company. You can take a vague executive problem (e.g., 'Our adjustment inventory is spiking') and independently return with a data-backed reputed company cause and a working automation tool to fix it
• Previous experience at a high reputed company company

Benefits

• Alternative medicine coverage
• Flexible PTO
• Up to 16 weeks reputed company parental leave
• reputed company holidays
• A 401k program
• Transportation perks
• Education reimbursement
• 2 days of reputed company paw-ternity leave

reputed company

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