Senior Claims Systems Analyst – AI-Enabled

This is a fully remote position, open to applicants in Texas.

📋 Description

• Diagnose issues related to claims adjudication, pricing, benefits, configuration, and payment to uncover root causes.

• Utilize SQL and system data to pinpoint affected claims, assess financial exposure, and verify findings.

• Leverage AI tools such as Claude Code, Codex, and others to analyze code, implement fixes, compose tests, and generate Git pull requests for engineering review.

• Replicate defects, evaluate proposed solutions, and confirm accurate claims outcomes.

• Collaborate with Claims Operations and Engineering to resolve recurring issues, automate workflows, and enhance accuracy.

• Assist in developing automated controls, advanced editing/AI solutions, and workflow improvements to boost payment accuracy and minimize administrative costs.

• Contribute to the development of audit tools, policies, and procedures.

• Verify claims configuration, reimbursement methods, and processing logic.

⛳️ Requirements

• Over 5 years of practical experience in the healthcare payer sector, encompassing claims adjudication, pricing, benefits, and reimbursement.

• Experience in configuring or troubleshooting production claims platforms (e.g., HealthRules Payer, Facets, Trizetto, or proprietary systems).

• Strong proficiency in SQL; ability to trace issues across data, configuration, and application logic.

• Hands-on experience with AI coding tools such as Claude Code, Codex, or similar for code creation or modification.

• Familiarity with Git, PRs, testing, and Python or a comparable scripting language.

• Proficient in Google Workspace with experience in audit tracking systems and data analytics tools (Snowflake, Streamlit, Claude).

• Capability for independent problem-solving and effective communication with claims stakeholders and software engineers.

• BA/BS degree in a relevant field.

• Certification or significant experience with ICD-10CM, MS-DRG, AP-DRG, and APR-DRG coding standards.

• Experience in validating claims configuration.

• Background in a fast-paced, growth-oriented environment.

🏝️ Benefits

• Curative Health Plan (100% employer-paid medical premiums for you and 50% coverage for dependents on the base plan.)

• $0 copays and $0 deductibles (upon completion of our Baseline Visit)

• Preventive and primary care included

• Mental health support available

• One-on-one care navigation services

• Programs for chronic conditions (diabetes, weight management, hypertension)

• Support for maternity and family planning

• Access to Curative Telehealth 24/7/365

• Pharmacy benefits included

• Comprehensive dental and vision insurance

• Employer-sponsored life and disability insurance with additional supplemental options

• Flexible spending accounts available

• Generous PTO policy along with 11 paid company holidays annually

• 401K plan for full-time employees

• Generous paid parental leave of up to 8–12 weeks, depending on role eligibility.