Sr Claims Systems Analyst — AI-Enabled

Curative-HR-LLC; Austin (TX); On-site; USD 120,000 - 170,000; Full time

Benefits offered by this job

100% employer-covered medical premiums

Generous PTO

401K

Parental leave 8–12 weeks

Life and disability coverage

Job summary

Curative seeks a technically skilled healthcare claims expert to investigate complex claims processing issues and translate findings into system fixes. This role spans Claims Operations and Engineering, leveraging Claude Code and Codex to improve our core processing platform.

You will work across teams to diagnose production issues, quantify impact, and deliver engineering-ready pull requests that enhance accuracy and reduce costs.

Qualifications

• 5+ years in healthcare payer environments with claims adjudication, pricing, benefits, and reimbursement.
• Experience configuring and troubleshooting production claims platforms.
• Strong SQL skills and ability to trace issues across data and configuration.

Responsibilities

• Investigate claims adjudication, pricing, benefits and configuration issues to identify root causes.
• Use SQL and data insights to quantify impact and validate findings.
• Develop fixes and tests using Claude Code/Codex; prepare engineering-ready PRs for review.

Skills

Healthcare claims

SQL

Claude Code

Codex

Python

Git

Education

BA/BS degree in related field

Tools

HealthRules Payer

Facets

Trizetto

Claude

Snowflake

Streamlit

Job description

Curative is building the future of health insurance with a first-of-its-kind employer-based plan designed to remove financial barriers and make care truly accessible: one monthly premium with $0 copays and $0 deductibles*.

Backed by our recent $150M in Series B funding and valuation at $1.275B, Curative is scaling rapidly and investing in AI-powered service, deeper member engagement, and a smart network designed for today’s workforce.

Our north star guides everything we do: healthcare only works when people can actually use it. That belief drives every decision we make: from how we design our plan, support our members, to how we collaborate as a team.

If you want to do meaningful work with a team that moves fast, experiments boldly, and cares deeply, Curative is the place to do it. We’re growing fast and looking for teammates who want to help transform health insurance for the better.

About the role

At Curative, we’re challenging the status quo in healthcare by removing barriers to care and creating a health plan experience that is transparent, proactive, and built around member health outcomes. Curative is seeking a technically skilled healthcare claims expert who can investigate complex claims processing issues and turn findings into actionable system fixes. This role combines deep claims adjudication knowledge with modern AI-assisted development tools, including Claude Code and OpenAI Codex. You will work across Claims Operations and Engineering to diagnose production issues, quantify impact, and create tested, engineering-ready pull requests (PRs) that improve our core claims processing platform.

We need someone who can do more than identify a problem—they can help build the solution.

What you will do

Investigate: Troubleshoot claims adjudication, pricing, benefits, configuration and payment issues to identify root causes.

Analyze: Use SQL and system data to identify affected claims, quantify financial exposure and validate findings.

Build: Use Claude Code, Codex and similar AI tools to investigate code, develop fixes, write tests and create Git pull requests for engineering review.

Validate: Reproduce defects, test proposed corrections and verify accurate claims outcomes.

Improve: Partner with Claims Operations and Engineering to eliminate recurring issues, automate workflows and improve accuracy. Support the implementation of automated controls, advanced editing/AI solutions, and workflow enhancements to improve payment accuracy, reduce administrative costs, and contribute to the development of audit tools, policies, and procedures.

Champion: Ensure operational excellence by validating claims configuration, reimbursement methodologies, and processing logic.

What you will bring

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.

Ideal candidate: A hands-on claims systems specialist who knows payer operations, embraces AI-assisted development and can independently move an issue from investigation to an engineering-ready fix. These skills and competencies are also important for success:

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

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

Chronic condition programs (diabetes, weight, hypertension)

Maternity and family planning support

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.