Technical Analyst - Claims Automation
Core
Drive auto-adjudication and workflow optimization by identifying manual claim scenarios and designing systemic solutions for claims processing.
Role type
Technical Analyst (Claims Automation)
Builds
Automated claims adjudication workflows and system enhancements
Domain
Healthcare / Insurance Claims Processing
Deliverable
production ML models | product features
Required skills
Claims adjudication process knowledge, SQL, process automation design, system logic analysis, business requirements translation, cross-functional collaboration
Preferred skills
Javelina platform familiarity, EDI formats (837/835), medical coding systems, vendor management, SLA monitoring
Technologies
SQL, EDI (837/835), Javelina
Responsibilities
Identify high-volume manual claim scenarios for automation, Design and implement automation enhancements within the claims processing system, Partner with engineering and vendors to expand auto-adjudication capabilities, Analyze claims workflows and system logic to identify inefficiencies, Translate business requirements into technical solutions, Document automation workflows and business rules, Monitor auto-adjudication performance metrics, Support testing and validation of system changes, Support EDI workflows and troubleshoot transaction issues
Seniority
Mid-level, hands-on IC
