Senior Claims Systems Analyst – AI-Enabled

🔥 0 minutes ago

🤠 Texas – Remote

🤠 Texas – Remote

💵 $110k - $165k / year

⏰ Full Time

🟠 Senior

⚙️ Systems Engineer

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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

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

• 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 automated controls, advanced editing/AI solutions and workflow enhancements to improve payment accuracy and reduce administrative costs. • Contribute to audit tools, policies and procedures. • Validate claims configuration, reimbursement methodologies and processing logic.

🎯 Requirements

• 5+ years of hands-on healthcare payer experience, including claims adjudication, pricing, benefits and reimbursement. • Production claims-platform configuration or troubleshooting experience (e.g., HealthRules Payer, Facets, Trizetto, or proprietary systems). • Strong SQL skills; 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, PRs, testing and Python or comparable scripting. • Proficiency in Google Workspace and experience with audit tracking systems and data analytics tools (Snowflake, Streamlit, Claude). • Independent problem-solving and clear communication with claims stakeholders and software engineers. • BA/BS degree in a related field. • Certification / 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.

🏖️ 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 full-time employees • Generous Up to 8–12 weeks paid parental leave, based on role eligibility.