Decision Scientist

fractal-analytics.framer.ai

Claims adjudication and payment integrity
Edi x12 interfaces and fhir apis
Genai solutioning and classical analytics
Own end-to-end problem solving for claims operations to improve auto-adjudication, reduce rework/denials, and modernize integrations

Job Summary

  • Own end-to-end problem solving for claims operations to improve auto-adjudication, reduce rework/denials, and modernize integrations.
  • Partner with business, data, and engineering to deliver measurable gains in first-pass adjudication, throughput, and cost-per-claim.
  • Apply GenAI/NLP for denial reasoning extraction and claim note summarization with HITL.

Matching Summary

Own end-to-end problem solving for claims operations to improve auto-adjudication, reduce rework/denials, and modernize integrations.

Skills & Requirements

Must-have

  • Claims adjudication and payment integrity
  • EDI X12 interfaces and FHIR APIs
  • GenAI solutioning and classical analytics
  • US healthcare consulting experience
  • HIPAA Privacy/Security knowledge
  • Stakeholder management and requirements elicitation

Nice-to-have

  • Working with happy, enthusiastic over-achievers
  • Wild growth opportunities
  • Provider outreach alignment
  • Executive storytelling and workshop facilitation

Key Requirements

  • 6-10 years techno-functional experience
  • 6-10 years US healthcare consulting
  • Hands-on claims adjudication experience
  • Working knowledge of HIPAA
  • Practical GenAI solutioning experience

Work Rights

Not specified

Tailored Resume

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