Decision Scientist

Fractal

Claims adjudication
Payment integrity
Edi x12 interfaces
Own end-to-end problem solving for claims operations: improve auto-adjudication, reduce rework/denials, and modernize integrations

Job Summary

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

Skills & Requirements

Must-have

  • claims adjudication
  • payment integrity
  • EDI X12 interfaces
  • GenAI solutioning
  • cloud data tools
  • stakeholder management

Nice-to-have

  • wild growth
  • happy enthusiastic over-achievers
  • provider outreach
  • executive storytelling

Key Requirements

  • 6-10 years US healthcare consulting
  • Hands-on claims adjudication
  • Working knowledge of HIPAA
  • Techno-functional experience
  • Practical GenAI experience
  • Exposure to cloud/data tools
  • Proven proposal/RFP experience

Work Rights

Not specified

Tailored Resume

Cover Letter