Sr Claims Systems Analyst — AI-Enabled
New
J
JobgetherHealthcare claims
Based in the United StatesFull-TimeSenior
Salary110,000 - 165,000 USD per year
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Job Details
- Experience
- At least 5 years of hands-on healthcare payer experience
- Required Skills
- PythonSQLGitSnowflakeGoogle Workspace
Requirements
- At least 5 years of hands-on healthcare payer experience, including claims adjudication, pricing, benefits administration, and reimbursement.
- Experience configuring or troubleshooting production claims platforms such as HealthRules Payer, Facets, TriZetto, or proprietary systems.
- Strong SQL skills and ability to trace issues across data, configuration, and application logic.
- Practical experience using AI-assisted coding tools such as Claude Code, OpenAI Codex, or equivalent to create or modify code.
- Working knowledge of Git, pull request workflows, software testing, and Python or comparable scripting languages.
- Proficiency in Google Workspace and experience with audit tracking systems and data analytics tools.
- Experience validating claims configurations and reimbursement logic.
- Ability to manage issues from investigation through solution development and communicate technical findings to claims professionals and software engineers.
- A bachelor's degree in a related field is preferred.
- Certification or substantial experience with ICD-10-CM, MS-DRG, AP-DRG, and APR-DRG coding standards is desirable.
Responsibilities
- Investigate complex claims adjudication, pricing, benefits, configuration, and payment issues to identify causes and solutions.
- Use SQL and system data to trace processing issues, identify affected claims, quantify financial exposure, and validate findings.
- Apply AI-assisted coding tools to investigate application code, develop fixes, write tests, and prepare Git pull requests for engineering review.
- Reproduce defects, test proposed corrections, and verify claims outcomes.
- Collaborate with Claims Operations and Engineering to resolve production issues and reduce recurring defects.
- Support automated controls, claims editing, AI-enabled solutions, and workflow enhancements.
- Contribute to audit tools, operational policies, procedures, and monitoring processes.
- Validate claims configurations, reimbursement methodologies, and processing logic.
- Translate technical findings into actionable recommendations for claims stakeholders and software engineers.
- Improve the claims platform through automation, structured testing, and process improvement.
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