Claims AI Business Analyst IV

Job not on LinkedIn

🕒 July 16

🇺🇸 United States – Remote

💵 $94.1k - $164.8k / year

⏰ Full Time

🟠 Senior

🔴 Lead

🧐 Business Analyst

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CareSource

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 30+ years

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

CareSource is a health services company focused on providing affordable health insurance and healthcare solutions. It offers a wide range of plans including Medicaid, Marketplace, and Medicare Advantage, targeting low-income adults, families, children, pregnant women, elderly adults, and people with disabilities. Additionally, CareSource provides members with resources for COVID-19 support, dental, vision, and hearing benefits, as well as pharmacy services. The company emphasizes easy access to healthcare management through online platforms and a mobile app.

📋 Description

• Driving end-to-end process transformation initiatives across Claims Operations • Leveraging automation and artificial intelligence (AI) to improve efficiency, reduce costs, and enhance quality • Serving as the primary owner of the Claims Operations automation and AI pipeline • Leading cross-functional initiatives from intake through implementation and post-production stabilization • Conducting detailed analysis of workflows to identify inefficiencies, bottlenecks, and automation opportunities

🎯 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 • 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

🏖️ Benefits

• Health insurance • Retirement plans • Paid time off • Flexible work arrangements • Professional development • Bonuses • Comprehensive total rewards package