SPE-Claims HC

Job Summary

This hybrid role for a Claims Healthcare Specialist Product Engineer focuses on designing developing and securing claims processing solutions using advanced software practices MS Excel analytics and generative AI ensuring accurate adjudication and compliance for healthcare stakeholders while improving operational efficiency and patient centric outcomes across the organization.

Responsibilities

• Design robust healthcare claims processing solutions that streamline adjudication workflows and enhance accuracy across core business processes for internal and external stakeholders.
• Develop modular software components for claims intake validation and settlement that are optimized for maintainability performance and alignment with healthcare compliance standards.
• Apply MS Excel to build detailed data analysis models dashboards and reconciliation reports that highlight claims trends anomalies and process optimization opportunities.
• Implement software security requirements across claims applications by defining secure data handling patterns and enforcing controls that protect sensitive health information throughout its lifecycle.
• Use generative AI techniques to design and refine intelligent features such as automated documentation assistance and claim pattern detection that reduce manual effort and error rates.
• Collaborate with business analysts and healthcare operations teams to translate claims policies benefit rules and regulatory constraints into clear and testable software requirements.
• Conduct unit integration and regression testing of claims modules to confirm functional accuracy security behavior and end to end reliability in line with agreed quality standards.
• Maintain detailed technical documentation for claims solutions including design decisions security considerations and configuration guidelines to support continuous improvement and onboarding.
• Monitor production claims systems by reviewing logs error reports and performance metrics then implement targeted fixes and enhancements that sustain system stability and user satisfaction.
• Optimize existing claims workflows by analyzing operational data in MS Excel and proposing focused automation or rule refinements that shorten settlement timelines and reduce rework.
• Integrate generative AI services into claims platforms in a controlled manner by validating models against healthcare data quality expectations and documenting safeguards for responsible use.
• Coordinate with cybersecurity and compliance specialists to ensure all claims software releases satisfy current healthcare privacy regulations and internal risk management policies.
• Contribute to cross functional initiatives that use claims insights to improve care pathways and cost transparency reinforcing the company mission to deliver better health outcomes and societal impact.
  
  

Qualifications

• Demonstrate between two and four years of hands on experience in software design and development with specific exposure to healthcare or financial claims systems considered a strong asset.
• Possess strong practical skills in MS Excel including formulas pivot analysis and data validation combined with solid understanding of software security requirements in regulated environments.
• Show working experience with generative AI concepts and tools applied to documentation support pattern discovery or workflow optimization within enterprise technology contexts.
• Bring domain knowledge in healthcare claims processing or insurance operations as a required competency with familiarity across related regulatory and compliance frameworks viewed as beneficial.
• Offer good to have experience in adjacent domains such as provider billing policy administration or clinical data integration that deepens perspective on end to end healthcare value chains.
• Work within a hybrid model that balances on site collaboration and remote productivity maintaining clear communication and reliable delivery of commitments in both settings.
• Operate primarily in a day shift schedule that supports coordination with global stakeholders while preserving flexibility for project demands and incident support when needed.
• Accept that this position does not require routine travel while remaining open to occasional short visits that may be arranged for critical workshops or stakeholder engagements.
• Communicate effectively in English through documentation analysis discussions and solution presentations enabling alignment among technical and nontechnical participants.
  
  

Certifications Required

Preferred certifications include AZ 900 Microsoft Azure Fundamentals or equivalent security focused credential relevant to enterprise software solutions.