Provider Claims & Payment Analyst

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🤠 Texas – Remote

🤠 Texas – Remote

💵 $80k - $105k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🧐 Analyst

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Curative

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 2020

🏥 Healthcare

🛡️ Insurance

Healthcare • Insurance

Curative is an employer-focused health insurance company offering a next-generation group health plan that emphasizes affordability, engagement, and simplicity. Their plans promise $0 in-network copays, $0 deductibles, and a single competitive monthly premium, along with a broad provider network, telehealth, an extensive $0-preferred prescription formulary, care navigators, and the Curative Cash Card to eliminate out-of-pocket costs in many settings. Curative markets to employers and brokers while providing members with resources like a Baseline Visit, care programs, online portals, and pharmacy services, and holds an A- rating from AM Best and HITRUST r2 certification.

📋 Description

• Investigate complex provider payment issues, including denials, under/overpayments, fee schedule discrepancies, and disputed claims. • Review contracts, reimbursement methodologies, and claims data to determine accurate payment outcomes and coordinate corrective adjustments. • Prepare evidence-based responses and document findings for provider disputes, Joint Operating Committee (JOC) meetings, and regulatory inquiries. • Analyze and reconcile provider-submitted spreadsheets and supporting documentation to identify payment variances and trends. • Coordinate authorized claims adjustments, payment corrections, and other corrective actions. • Analyze claims data to identify recurring operational bottlenecks, systemic errors, and financial impacts. • Partner with Contracting, Compliance, Finance, and IT to implement sustainable solutions and prevent recurring errors. • Develop operational reporting to track turnaround times, dispute trends, and implemented improvements. • Utilize approved AI tools (ChatGPT, Claude, Codex) to streamline research, query data, and generate analytical summaries. • Validate AI-assisted outputs against primary claims data while maintaining HIPAA and data security compliance. • Collaborate with Claims, Provider Relations, Contracting, Compliance, Finance, Technology, and Operations. • Participate in JOC meetings and provider discussions involving payment discrepancies, disputes, trends, and action plans. • Prepare data-driven presentations, summaries, and recommendations. • Communicate complex claims and reimbursement findings to technical and nontechnical audiences. • Monitor claims and dispute activity for emerging risks, bottlenecks, and improvement opportunities. • Recommend improvements to increase accuracy, efficiency, compliance, and provider satisfaction. • Track and communicate measurable results of implemented improvements. • Maintain accurate documentation and meet quality, service-level, contractual, and regulatory requirements.

🎯 Requirements

• Bachelor’s degree in Healthcare Administration, Business, Data Analytics, or a related field. • 3+ years of experience in health insurance claims operations, adjudication, provider reimbursement, or dispute resolution. • Solid knowledge of claims lifecycles, fee schedules, contract terms, and reimbursement methodologies. • Strong proficiency with spreadsheet tools (reconciliations, pivot tables, lookups) and data analysis. • Familiarity with leveraging AI tools to enhance analytical workflows and productivity. • Excellent problem-solving, communication, and cross-functional collaboration skills. • Demonstrated curiosity, resourcefulness, and willingness to investigate problems beyond their immediate symptoms. • Strong organizational skills, attention to detail, and ability to manage multiple investigations and deadlines. • Preferred: 5+ years of healthcare payer claims or business analysis experience. • Preferred: Hands-on experience using generative AI tools (ChatGPT, Claude, Codex) for data research and process automation. • Preferred: Experience presenting findings to providers or managing regulatory inquiries. • Preferred: Familiarity with claims configuration, payment policies, and operational controls.

🏖️ Benefits

• Curative Health Plan (100% employer-covered medical premiums for you and 50% coverage for dependents on the base plan.) • $0 copays and $0 deductibles (with completion of our Baseline Visit) • Preventive and primary care built in • Mental health support • One-on-one care navigation • Chronic condition programs (diabetes, weight, 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 plus 11 paid annual company holidays • 401K for employees • Generous Up to 8–12 weeks paid parental leave, based on role eligibility.

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