Example Company
Software engineer
- Location
- San Francisco
- Type
- Full time
- Compensation
- $150k-$200k
- Posted
- 2 days ago
Join a team building useful software. Work closely with engineering and design to turn new ideas into products.
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Provider Claims & Payment Analyst
- Location
- Remote
- Type
- Full time
- Compensation
- $80,000 - $105,000
- Posted
- 1H AGO
About the role
About Curative
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
We are seeking an experienced health insurance claims professional who thrives on solving complex problems, analyzing data, and finding better ways to operate. The Provider Claims & Payment Analyst will help advance how we manage healthcare claims, provider payments, disputes, and operational performance. This is a healthcare claims operations role, not a software engineering or AI development position.
This role combines the expertise of a traditional health insurance claims analyst with the investigative, analytical, and process improvement capabilities of a business analyst. The ideal candidate has a strong understanding of health insurance claims adjudication, provider reimbursement, payment disputes, and operational workflows.
Rather than simply resolving individual claims issues, this individual will look beyond the immediate problem to understand root causes, identify patterns, quantify impacts, and develop sustainable solutions. As our operations environment evolves, we increasingly use artificial intelligence and modern analytical tools to accelerate research, uncover insights, improve workflows, and strengthen decision-making. The successful candidate will be comfortable learning and applying tools such as ChatGPT, Claude, and Codex, while maintaining strong judgment, data accuracy, compliance, and accountability.
We are looking for someone who is equally comfortable researching a complex claim, analyzing a spreadsheet, collaborating with providers, and exploring how technology can help prevent recurring problems.
Key Responsibilities
Claims Investigation & Provider Payment Resolution
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Investigate complex provider payment issues, including denials, under/overpayments, fee schedule discrepancies, and disputed claims.
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Review contracts, reimbursement methodologies, and claims data to determine accurate payment outcomes and coordinate corrective adjustments.
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Prepare evidence-based responses and document findings for provider disputes, joint operating committee (JOC) meetings, and regulatory inquiries.
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Analyze and reconcile provider-submitted spreadsheets and supporting documentation to identify payment variances and trends.
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Coordinate authorized claims adjustments, payment corrections, and other corrective actions.
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Investigate provider disputes and regulatory inquiries, maintaining accurate documentation and meeting applicable response deadlines.
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Prepare clear, evidence-based findings, responses, and recommendations for internal stakeholders, providers, and regulatory matters.
Business Analysis & Root-Cause Investigation
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Analyze claims data to identify recurring operational bottlenecks, systemic errors, and financial impacts.
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Partner cross-functionally with Contracting, Compliance, Finance, and IT to implement sustainable solutions and prevent recurring errors.
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Develop operational reporting to track turnaround times, dispute trends, and the performance of implemented improvements.
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Utilize approved AI tools (ChatGPT, Claude, Codex) to streamline repetitive research, query data, and generate analytical summaries.
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Critically validate AI-assisted outputs against primary claims data, maintaining strict HIPAA and data security compliance.
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Follow company data security, confidentiality, HIPAA, and approved AI-use requirements, including restrictions on sensitive information and protected health information.
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Share effective techniques and successful use cases that improve claim payment accuracy.
Provider Engagement & Cross-Functional Collaboration
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Collaborate with Claims, Provider Relations, Contracting, Compliance, Finance, Technology, and Operations to investigate and resolve complex issues.
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Participate in Joint Operating Committee (JOC) meetings and other provider discussions involving payment discrepancies, disputes, trends, and action plans.
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Prepare data-driven presentations, summaries, and recommendations for provider and internal stakeholder meetings.
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Clearly communicate complex claims and reimbursement findings to technical and nontechnical audiences.
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Coordinate corrective actions, monitor progress, and ensure appropriate follow-through.
Operational Performance & Continuous Improvement
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Monitor claims and dispute activity to identify emerging risks, operational bottlenecks, and improvement opportunities.
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Develop or contribute to reporting that tracks payment accuracy, dispute trends, root causes, turnaround times, and corrective action effectiveness.
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Identify opportunities to reduce rework, unnecessary manual activity, repeated provider inquiries, and preventable claims errors.
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Recommend practical improvements that increase accuracy, efficiency, compliance, and provider satisfaction.
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Track and communicate the measurable results of implemented improvements.
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Maintain accurate documentation and manage competing priorities while meeting quality, service-level, contractual, and regulatory requirements.
Required Qualifications
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Bachelor’s degree in Healthcare Administration, Business, Data Analytics, or a related field.
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3+ years of experience in health insurance claims operations, adjudication, provider reimbursement, or dispute resolution.
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Solid knowledge of claims lifecycles, fee schedules, contract terms, and reimbursement methodologies.
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Strong proficiency with spreadsheet tools (reconciliations, pivot tables, lookups) and data analysis.
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Familiarity with leveraging AI tools to enhance analytical workflows and productivity.
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Excellent problem-solving, communication, and cross-functional collaboration skills.
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Demonstrated curiosity, resourcefulness, and willingness to investigate problems beyond their immediate symptoms.
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Strong organizational skills, attention to detail, and ability to manage multiple investigations and deadlines.
Preferred Qualifications
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5+ years of healthcare payer claims or business analysis experience.
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Hands-on experience using generative AI tools (ChatGPT, Claude, Codex) for data research and process automation.
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Experience presenting findings to providers or managing regulatory inquiries.
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Familiarity with claims configuration, payment policies, and operational controls.
Perks & Benefits
-
Curative Health Plan (100% employer-covered medical premiums for you and 50% coverage for dependents on the base plan.)
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$0 copays and $0 deductibles (with completion of our Baseline Visit )
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Preventive and primary care built in
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Mental health support
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One-on-one care navigation
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Chronic condition programs (diabetes, weight, hypertension)
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Maternity and family planning support
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24/7/365 Curative Telehealth
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Pharmacy benefits
-
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Comprehensive dental and vision coverage
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Employer-provided life and disability coverage with additional supplemental options
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Flexible spending accounts
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Generous PTO policy plus 11 paid annual company holidays
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401K for employees
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Generous Up to 8–12 weeks paid parental leave, based on role eligibility.
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