Senior Claims Optimization Analyst

🔥 12 minutes ago

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

Gravie

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 2013

🏥 Healthcare

🛡️ Insurance

🤝 B2B

💰 $150M Private Equity Round - Gravie on 2025-05

Healthcare • Insurance • B2B

Gravie is a benefits and health insurance solutions company that helps small and midsize employers, brokers, and employees access and administer more flexible, affordable health benefits. Its flagship offerings include Comfort (a level-funded health plan), Gravie ICHRA (Individual Coverage Health Reimbursement Arrangement administration), Gravie Pay (support for healthcare costs), and Gravie Care; the company focuses on enabling SMBs to offer individualized, lower-cost coverage and simplifying benefits administration.

📋 Description

• Proactively Uncover Friction: Independently execute deep-dive data mining across complex claims databases to identify operational friction, inefficiencies, handoff issues, and sources of waste or leakage ripe for automation. • Architect Advanced Automations: Design and deploy production-grade scripts (Python, R, or advanced RPA platforms) that can cross-reference multiple systems via APIs to handle bulk claims adjustments and auto-adjudication paths safely. • Lead AI & Prompt Engineering: Own the operational deployment and fine-tuning of generative AI and agentic workflows. You will build and test the prompts that allow AI to accurately interpret claims, provider appeals, and medical records to improve cycle times. • Protect the Ecosystem: Monitor automated scripts and bots against upstream system updates or configuration changes, ensuring zero downtime in our automated production workflows. • Partner Cross-Functionally: Translate complex operational roadblocks into clean, technical requirements when partnering with core Engineering, while translating technical automation impacts into plain English for Claims leadership. • Own End-to-End Delivery: Manage the UAT (User Acceptance Testing) process, deployment strategy, and post-launch monitoring for large-scale automation initiatives, ensuring solutions deliver the intended outcome..

🎯 Requirements

• 5+ years of progressive experience in healthcare operations analytics, process engineering, or automation delivery • Advanced SQL mastery alongside deep comfort writing production-ready Python or similar scripting languages that interact with APIs and databases • Proven track record of successfully implementing automation frameworks and a deep interest or hands-on experience leveraging LLMs/AI to solve operational bottlenecks or extract structured information from unstructured data • Intimate knowledge of claims adjudication systems, claim routing logic, and how a Payment Integrity program impacts downstream provider dispute workflows • You don't need a blueprint. You can take a vague executive problem (e.g., "Our adjustment inventory is spiking") and independently return with a data-backed root cause and a working automation tool to fix it.

🏖️ Benefits

• Alternative medicine coverage • Flexible PTO • Up to 16 weeks paid parental leave • Paid holidays • 401k program • Transportation perks • Education reimbursement • 2 days of paid paw-ternity leave