Senior Claims Optimization Analyst

Role Description

We’re looking for a Senior Claims Optimization Analyst. The Senior Claims Optimization Analyst is a highly autonomous individual contributor role designed to bridge the gap between complex claims databases and enterprise scalability. You will be the architect of our advanced automation framework and serve as the primary owner/subject matter expert for leveraging advanced scripting, APIs, and agentic AI to decouple our operational spend from membership growth. This role will own proactively mining data to uncover hidden operational leakage and engineering the sophisticated workflows that eliminate it. You will work closely with Claims and Payment Integrity leadership to identify high-impact opportunities and partner directly with core Engineering and Product teams to deploy scalable solutions.

• 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.

Qualifications

• Experience: 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.
• The Technical Toolkit: Advanced SQL mastery alongside deep comfort writing production-ready Python or similar scripting languages that interact with APIs and databases.
• AI & Automation Portfolio: 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.
• Payer Expertise: Intimate knowledge of claims adjudication systems, claim routing logic, and how a Payment Integrity program impacts downstream provider dispute workflows.
• Autonomy: 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.

Nice to have

• Previous experience at a high growth company.

Benefits

• Our unique benefits program is the gravy, i.e., the special sauce that sets our compensation package apart.
• In addition to standard health and wellness benefits, Gravie’s package includes 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.