Senior Claims Optimizations Analyst
Core
Architect advanced automation frameworks and agentic AI workflows to decouple operational spend from membership growth by mining claims data and eliminating leakage.
Role type
Senior IC claims optimization and automation engineer
Builds
Production-grade scripts, API integrations, and AI-driven auto-adjudication paths for claims databases
Domain
Health insurance / Claims operations / Process automation
Deliverable
production ML models | product features
Required skills
Advanced SQL, Python scripting, API integration, Generative AI & Prompt Engineering, Claims adjudication logic, Data mining, Automation framework design, UAT management
Preferred skills
Experience at high-growth companies
Technologies
Python, R, RPA platforms, LLMs, APIs
Responsibilities
Execute deep-dive data mining to identify operational friction and waste; Design and deploy production-grade scripts for bulk claims adjustments; Lead operational deployment and fine-tuning of generative AI workflows; Monitor automated scripts against system updates; Partner with Engineering and Claims leadership to translate operational roadblocks into technical requirements; Manage end-to-end delivery including UAT and post-launch monitoring
Seniority
Senior, hands-on IC
