Claims AI Business Analyst IV

CareSource•Dayton, OH

19h•$94,100 - $164,800•Onsite

About The Position

The Claims AI Business Analyst IV is responsible for driving end-to-end process transformation initiatives across Claims Operations by leveraging automation and artificial intelligence (AI) to improve efficiency, reduce costs, and enhance quality. This role operates as both a hands-on analyst and initiative owner, with accountability for the full lifecycle of work including intake, prioritization, design, implementation, and sustained value realization. They serve as the primary owner of the Claims Operations automation and AI pipeline, ensuring alignment to business priorities and measurable return on investment.

Requirements

Bachelor's degree in Business, Operations, Information Systems, or related field required
Equivalent years of relevant work experience may be accepted in lieu of required education
Seven (7) years experience in business analysis, process improvement, or operations optimization required
Demonstrated ability to lead cross-functional initiatives and drive outcomes
Ability to translate business requirements into technical solutions and work with IT teams
Strong analytical and problem-solving skills
Ability to break down complex processes into actionable components
Strong stakeholder management and influence skills
Ability to manage multiple priorities and competing demands
Effective verbal and written communication skills

Nice To Haves

Experience with agentic AI, LLM architectures, prompt engineering, RAG, and evaluation metrics strongly preferred
Experience in the healthcare payer industry and knowledge of claims operations preferred

Responsibilities

Establish and maintain a structured pipeline/backlog aligned to business priorities and ROI potential.
Partner with leadership to assess demand, size opportunities, and prioritize work based on impact and feasibility.
Serve as liaison between business, IT, and AI teams to align intake with enterprise processes.
Lead cross-functional initiatives from intake through implementation and post-production stabilization.
Drive stakeholder alignment, decision-making, and accountability through influence without direct authority.
Ensure initiatives are clearly scoped, sequenced, and delivered against defined timelines and outcomes.
Conduct detailed analysis of workflows to identify inefficiencies, bottlenecks, and automation opportunities.
Apply process improvement methodologies (e.g., process mapping, workflow redesign, root cause analysis).
Develop current-state and future-state workflows to improve throughput, quality, and scalability.
Evaluate processes for automation and AI applicability (e.g., GenAI, RPA, workflow tools, decision engines).
Translate operational challenges into scalable, technology-enabled solutions.
Partner with Automation and IT teams to define solution approach, feasibility, and implementation strategy.
Facilitate and lead implementation efforts across Operations, IT, AI teams, and external vendors.
Facilitate working sessions, remove blockers, and drive execution progress.
Support testing, validation, and user acceptance activities.
Define expected ROI upfront, including cost savings, productivity, and quality improvements.
Track and report realized value post-implementation.
Develop executive-level reporting to demonstrate impact and support prioritization decisions.
Ensure implemented solutions are stable and embedded into operational workflows.
Establish monitoring, controls, and documentation to sustain performance.
Drive adoption, training, and continuous optimization of solutions.
Perform any other job related duties as requested.