Claims Automation Analyst — Auto-Adjudication & Workflow

Gravie; Poland; Remote; PLN 120,000 - 180,000; Full time

Benefits offered by this job

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

Job summary

Gravie in Poland is seeking a Technical Analyst focusing on Claims Automation to join our configuration team. You will drive auto-adjudication and workflow optimization by identifying manual claim scenarios and designing systemic solutions.

You will partner with engineering, vendors, including Mphasis, to expand automated capabilities, improve efficiency and reduce per-claim costs. The role requires 3+ years in claims systems and strong analytical skills.

Qualifications

• 3+ years of experience in claims systems, business analysis, or healthcare IT.
• Understanding of claims adjudication processes and workflow logic.
• Translate complex business problems into technical requirements.
• Strong analytical and problem-solving skills with attention to detail.
• Experience cross-functionally with engineering, operations and vendor partners.

Responsibilities

• 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.

Skills

Claims systems

SQL

Analytical skills

Business analysis

Tools

EDI tools

Javelina

Job description

Gravie in Poland is seeking a Technical Analyst focusing on Claims Automation to join our configuration team. You will drive auto-adjudication and workflow optimization by identifying manual claim scenarios and designing systemic solutions.

You will partner with engineering, vendors, including Mphasis, to expand automated capabilities, improve efficiency and reduce per-claim costs. The role requires 3+ years in claims systems and strong analytical skills.