Sr Claims Systems Analyst — AI-Enabled

📋 Description

• Investigate complex claims adjudication, pricing, benefits, configuration, and payment issues to
• Use SQL and system data to trace processing issues, identify affected claims, quantify financial
• Apply AI-assisted coding tools, including Claude Code, OpenAI Codex, or equivalent platforms, to
• Reproduce defects, test proposed corrections, and verify that changes produce accurate claims
• Collaborate with Claims Operations and Engineering teams to resolve production issues, eliminate
• Support the implementation of automated controls, advanced claims editing and AI-enabled solutions

🎯 Requirements

• At least 5 years of hands-on healthcare payer experience, including claims adjudication, pricing
• Experience configuring or troubleshooting production claims platforms, such as HealthRules Payer
• Strong SQL skills and the ability to trace issues across data, configuration, and application logic.
• Practical experience using AI-assisted coding tools, such as Claude Code, OpenAI Codex, or
• Working knowledge of Git, pull request workflows, software testing, and Python or comparable
• Proficiency in Google Workspace and experience with audit tracking systems and data analytics

🎁 Benefits

• Annual salary: $110,000–$165,000.
• Medical coverage: Employer-paid medical premiums for employees and 50% coverage for dependents
• Healthcare access: $0 copays and $0 deductibles upon completion of the required Baseline Visit, as
• Preventive and primary care: Integrated care services designed to support ongoing health and
• Mental health support: Access to mental health resources.
• Care navigation: One-on-one assistance navigating healthcare services.