Job Summary:The Claims AI Business Analyst IV is responsible for driving end-to-end process transformation initiatives across Claims Operations by leveraging automation and artificial intelligence (AI) to improve efficiency, reduce costs, and enhance quality. This role operates as both a hands-on analyst and initiative owner, with accountability for the full lifecycle of work including intake, prioritization, design, implementation, and sustained value realization. They serve as the primary owner of the Claims Operations automation and AI pipeline, ensuring alignment to business priorities and measurable return on investment.
Essential Functions:- Establish and maintain a structured pipeline/backlog aligned to business priorities and ROI potential.
- Partner with leadership to assess demand, size opportunities, and prioritize work based on impact and feasibility.
- Serve as liaison between business, IT, and AI teams to align intake with enterprise processes.
- Lead cross-functional initiatives from intake through implementation and post-production stabilization.
- Drive stakeholder alignment, decision-making, and accountability through influence without direct authority.
- Ensure initiatives are clearly scoped, sequenced, and delivered against defined timelines and outcomes.
- Conduct detailed analysis of workflows to identify inefficiencies, bottlenecks, and automation opportunities.
- Apply process improvement methodologies (e.g., process mapping, workflow redesign, root cause analysis).
- Develop current-state and future-state workflows to improve throughput, quality, and scalability.
- Evaluate processes for automation and AI applicability (e.g., GenAI, RPA, workflow tools, decision engines).
- Translate operational challenges into scalable, technology-enabled solutions.
- Partner with Automation and IT teams to define solution approach, feasibility, and implementation strategy.
- Facilitate and lead implementation efforts across Operations, IT, AI teams, and external vendors.
- Facilitate working sessions, remove blockers, and drive execution progress.
- Support testing, validation, and user acceptance activities.
- Define expected ROI upfront, including cost savings, productivity, and quality improvements.
- Track and report realized value post-implementation.
- Develop executive-level reporting to demonstrate impact and support prioritization decisions.
- Ensure implemented solutions are stable and embedded into operational workflows.
- Establish monitoring, controls, and documentation to sustain performance.
- Drive adoption, training, and continuous optimization of solutions.
- Perform any other job related duties as requested.
Education and Experience:- Bachelor's degree in Business, Operations, Information Systems, or related field required
- Equivalent years of relevant work experience may be accepted in lieu of required education
- Seven (7) years experience in business analysis, process improvement, or operations optimization required
- Experience with agentic AI, LLM architectures, prompt engineering, RAG, and evaluation metrics strongly preferred
- Experience in the healthcare payer industry and knowledge of claims operations preferred
Competencies, Knowledge and Skills:- Demonstrated ability to lead cross-functional initiatives and drive outcomes
- Ability to translate business requirements into technical solutions and work with IT teams
- Strong analytical and problem-solving skills
- Ability to break down complex processes into actionable components
- Strong stakeholder management and influence skills
- Ability to manage multiple priorities and competing demands
- Effective verbal and written communication skills
Licensure and Certification:Working Conditions:- General office environment; may be required to sit or stand for extended periods of time
- May be required to work additional hours and/or outside normal business hours as needed to meet deadlines.
- Travel is not typically required
Compensation Range:
$94,100.00 - $164,800.00
CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type (hourly/salary):
Salary
Organization Level Competencies
This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.
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