Technical Analyst - Claims Automation

We’re looking for a Technical Analyst focused on Claims Automation to join our configuration team. In this role, you will drive auto-adjudication and workflow optimization by identifying manual claim scenarios and designing systemic solutions. You will partner closely with engineering, vendors, and internal teams to expand automated capabilities, increase efficiency, and lower cost per claim.

Identify high-volume manual claim scenarios and evaluate opportunities for automation

Design and implement automation enhancements within the claims processing system

Partner with engineering and vendors, including Mphasis, to expand systemic and auto-adjudication capabilities

Analyze claims workflows and system logic to identify inefficiencies and recommend improvements

Translate business requirements into technical solutions aligned with claims processing standards

Document automation workflows, business rules, and system configurations

Monitor auto-adjudication performance metrics and identify opportunities to improve turnaround time and accuracy

Support testing and validation of system changes and automation enhancements

Demonstrate commitment to our core competencies of being authentic, curious, creative, empathetic, and outcome oriented

Support EDI workflows and troubleshoot transaction issues including 837 claim submissions and 835 remittance files in partnership with the EDI team

3+ years of experience in claims systems, business analysis, or healthcare IT

Understanding of claims adjudication processes and system workflow logic