Sr Claims Systems Analyst — AI-Enabled

Analyses du marché

Stack

Détails

Gratuit, après connexion.

Postuler

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Description

Accountabilities - Investigate complex claims adjudication, pricing, benefits, configuration, and payment issues to identify underlying causes and determine appropriate solutions. - Use SQL and system data to trace processing issues, identify affected claims, quantify financial exposure, and validate findings. - Apply AI-assisted coding tools, including Claude Code, OpenAI Codex, or equivalent platforms, to investigate application code, develop fixes, write tests, and prepare Git pull requests for engineering review. - Reproduce defects, test proposed corrections, and verify that changes produce accurate claims outcomes. - Collaborate with Claims Operations and Engineering teams to resolve production issues, eliminate recurring defects, and improve claims processing reliability. - Support the implementation of automated controls, advanced claims editing and AI-enabled solutions, and workflow enhancements to improve payment accuracy and reduce administrative costs. - Contribute to the development and improvement of audit tools, operational policies, procedures, and monitoring processes. - Validate claims configurations, reimbursement methodologies, and processing logic to ensure operational accuracy and consistency. - Translate technical findings into clear, actionable recommendations for claims stakeholders and software engineers. - Help improve the claims processing platform through practical automation, structured testing, and continuous process improvement. - Requirements

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