Sr Claims Systems Analyst — AI-Enabled
About The Position
Curative is seeking a technically skilled healthcare claims expert to investigate complex claims-processing issues and turn findings into actionable system fixes. The role combines claims adjudication expertise with AI-assisted development tools, including Claude Code and OpenAI Codex. Working across Claims Operations and Engineering, the analyst diagnoses production issues, quantifies impact, and creates tested, engineering-ready pull requests that improve Curative’s claims-processing platform. The analyst also helps improve operational accuracy by validating claims configuration, reimbursement methodologies, and processing logic; supporting automated controls and advanced editing or AI solutions; and contributing to audit tools, policies, procedures, and workflow enhancements. The ideal candidate understands payer operations, uses AI-assisted development, and can move an issue independently from investigation to an engineering-ready fix.
Requirements
- At least 5 years of hands-on healthcare payer experience, including claims adjudication, pricing, benefits, and reimbursement.
- Production claims-platform configuration or troubleshooting experience, such as HealthRules Payer, Facets, Trizetto, or proprietary systems.
- Strong SQL skills and ability to trace issues across data, configuration, and application logic.
- Practical experience using AI coding tools such as Claude Code, Codex, or equivalents to create or modify code.
- Working knowledge of Git, pull requests, testing, and Python or comparable scripting.
- Proficiency in Google Workspace and experience with audit tracking systems and data analytics tools such as Snowflake, Streamlit, and Claude.
- Independent problem-solving skills and clear communication with claims stakeholders and software engineers.
Nice To Haves
- BA/BS degree in a related field.
- Certification or substantial experience working with ICD-10CM, MS-DRG, AP-DRG, and APR-DRG coding standards.
- Experience with claims configuration validation.
- Experience working in a high-growth environment.
Responsibilities
- Troubleshoot claims adjudication, pricing, benefits, configuration, and payment issues to identify root causes.
- Use SQL and system data to identify affected claims, quantify financial exposure, and validate findings.
- Use Claude Code, Codex, and similar AI tools to investigate code, develop fixes, write tests, and create Git pull requests for engineering review.
- Reproduce defects, test proposed corrections, and verify accurate claims outcomes.
- Partner with Claims Operations and Engineering to eliminate recurring issues, automate workflows, and improve accuracy.
- Support implementation of automated controls, advanced editing and AI solutions, and workflow enhancements to improve payment accuracy and reduce administrative costs.
- Contribute to the development of audit tools, policies, and procedures.
- Validate claims configuration, reimbursement methodologies, and processing logic to support operational excellence.
Benefits
- Curative Health Plan with 100% employer-covered medical premiums for the employee and 50% coverage for dependents on the base plan.
- $0 copays and $0 deductibles with completion of the Baseline Visit.
- Preventive and primary care built in.
- Mental health support.
- One-on-one care navigation.
- Chronic condition programs for diabetes, weight, and hypertension.
- Maternity and family planning support.
- 24/7/365 Curative Telehealth.
- Pharmacy benefits.
- Comprehensive dental and vision coverage.
- Employer-provided life and disability coverage, with additional supplemental options.
- Flexible spending accounts.
- Generous PTO policy and 11 paid annual company holidays.
- 401K for full-time employees.
- Up to 8–12 weeks of paid parental leave, based on role eligibility.
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What This Job Offers
Job Type
Full-time
Career Level
Senior
Education Level
No Education Listed
