Operations Automation Specialist

Employer Direct Healthcare

. Resolve live provider claims inquiries involving status, payment amounts, denials, rejections, and aged-claim batches .

Posted 10/5/2026full-timeUnited StatesMid-LevelSenior💰 $90,000 - $120,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates strong SQL and Python skills to analyze claims and payment data, while effectively communicating with providers and stakeholders. Capable of designing AI-assisted workflows to improve inquiry resolution and enhance operational efficiency.

Highest-signal resume keywords

SQL ExperiencePython ProficiencyAI Tools FamiliarityClaims Processing KnowledgeProcess Improvement Background

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

SQLPythonData AnalysisClaims AuditingWorkflow Automation

Soft Skills

Clear CommunicationAttention to DetailProblem SolvingAdaptabilityCustomer Service Orientation

Tools & Technologies

AI ToolsAgentic Coding ToolsDatabricks

Industry Keywords

ClaimsPayer OperationsProvider BillingRevenue CycleFinancial Analysis

Tech Stack

Tools & technologies

PythonSQL

About the role

Key responsibilities & impact

Resolve live provider claims inquiries involving status, payment amounts, denials, rejections, and aged-claim batches
Audit individual claims across systems to confirm submission, validation, pricing, and payment accuracy
Escalate pricing or appeals determinations and document findings for future automation
Query claims, pricing, and provider data using SQL to characterize inquiry volume, root causes, and cost to serve
Distinguish real payment problems from provider visibility issues
Design and build AI-assisted workflows to triage inquiries, retrieve claim and contract facts, validate payments, and draft provider-ready responses
Build verification into automations, test against real ticket volume, measure impact, and iterate
Investigate upstream root causes such as deferred claims, ingestion errors, and notification gaps
Contribute to provider self-service
Independently resolve complex provider inquiries within three months
Launch measurable AI-assisted workflows and reduce manual handling and cost per resolved inquiry

Requirements

What you’ll need

Ability to communicate clearly and confidently with providers and internal stakeholders, including by phone
Working understanding of the business and financial side of claims and payments
Genuine desire to expand SQL skills and use Python and AI tools, including agentic coding tools like Claude Code
Careful attention to correctness and ability to build verification checks
Comfort working in ambiguity with thin documentation and inconsistent systems
Willingness to perform resolution work firsthand before automating it
Strongly preferred: hands-on SQL and/or Python experience and fluency with modern AI tools, with something built to demonstrate this
Strongly preferred: a year or more of work experience, including internship, part-time, or full-time experience
Strongly preferred: background or coursework in process improvement
Strongly preferred: business, finance, economics, or business-intelligence academic background
Strongly preferred: exposure to revenue cycle, claims, payer operations, or provider billing
Strongly preferred: support, service, or operations experience
Formal software engineering background or computer science degree is not required
Expert-level SQL, Python, or AI tooling experience is not required
Databricks or other enterprise data-engineering tooling experience is not required
No specific number of years of AI experience is required

Benefits

Comp & perks

Medical Insurance
Dental Insurance
Vision Insurance
Short & Long Term Disability
Life Insurance
401k with company match
Paid Time Off
Paid Parental Leave