Note: The job is a remote job and is open to candidates in USA. Gravie is dedicated to creating health benefits that truly support small and midsize businesses and their employees. They are seeking a Senior Claims Optimization Analyst to bridge complex claims databases and enterprise scalability, focusing on automation and operational efficiency.
Responsibilities
- 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
Skills
- 5+ years of progressive experience in healthcare operations analytics, process engineering, or automation delivery, with a mandatory background inside a health insurance plan or TPA
- Advanced SQL mastery alongside deep comfort writing production-ready Python or similar scripting languages that interact with APIs and databases
- A 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
- Previous experience at a high growth company
Benefits
- Alternative medicine coverage
- Flexible PTO
- Up to 16 weeks paid parental leave
- Paid holidays
- A 401k program
- Transportation perks
- Education reimbursement
- 2 days of paid paw-ternity leave
Company Overview
Company H1B Sponsorship