About the roleAt Curative, we're challenging the status quo in healthcare by removing barriers to care and creating a health plan experience that is transparent, proactive, and built around member health outcomes. Curative is seeking a technically skilled healthcare claims expert who can investigate complex claims processing issues and turn findings into actionable system fixes. This role combines deep claims adjudication knowledge with modern AI-assisted development tools, including Claude Code and OpenAI Codex. You will work across Claims Operations and Engineering to diagnose production issues, quantify impact, and create tested, engineering-ready pull requests (PRs) that improve our core claims processing platform.
We need someone who can do more than identify a problem-they can help build the solution. What you will do - Investigate: Troubleshoot claims adjudication, pricing, benefits, configuration and payment issues to identify root causes.
- Analyze: Use SQL and system data to identify affected claims, quantify financial exposure and validate findings.
- Build: Use Claude Code, Codex and similar AI tools to investigate code, develop fixes, write tests and create Git pull requests for engineering review.
- Validate: Reproduce defects, test proposed corrections and verify accurate claims outcomes.
- Improve: Partner with Claims Operations and Engineering to eliminate recurring issues, automate workflows and improve accuracy. Support the implementation of automated controls, advanced editing/AI solutions, and workflow enhancements to improve payment accuracy, reduce administrative costs, and contribute to the development of audit tools, policies, and procedures.
- Champion: Ensure operational excellence by validating claims configuration, reimbursement methodologies, and processing logic.
What you will bring - 5+ years of hands-on healthcare payer experience, including claims adjudication, pricing, benefits and reimbursement.
- Production claims-platform configuration or troubleshooting experience (e.g., HealthRules Payer, Facets, Trizetto, or proprietary systems).
- Strong SQL skills; ability to trace issues across data, configuration and application logic.
- Practical experience using AI coding tools such as Claude Code, Codex or equivalents to create or modify code.
- Working knowledge of Git, PRs, testing and Python or comparable scripting.
- Proficiency in Google Workspace and experience with audit tracking systems and data analytics tools (Snowflake, Streamlit, Claude).
- Independent problem-solving and clear communication with claims stakeholders and software engineers.
Ideal candidate: A hands-on claims systems specialist who knows payer operations, embraces AI-assisted development and can independently move an issue from investigation to an engineering-ready fix. These skills and competencies are also important for success:
- BA/BS degree in a related field
- Certification / substantial experience working with ICD-10CM, MS-DRG, AP-DRG, and APR-DRG coding standards.
- Experience with claims configuration validation
- Experience working in a high-growth environment
Perks & Benefits - Curative Health Plan (100% employer-covered medical premiums for you and 50% coverage for dependents on the base plan.)
- $0 copays and $0 deductibles (with completion of our Baseline Visit )
- Preventive and primary care built in
- Mental health support
- One-on-one care navigation
- Chronic condition programs (diabetes, weight, hypertension)
- Maternity and family planning support
- 24/7/365 Curative Telehealth
- Pharmacy benefits
- Comprehensive dental and vision coverage
- Employer-provided life and disability coverage with additional supplemental options
- Flexible spending accounts
- Generous PTO policy plus 11 paid annual company holidays
- 401K for full-time employees
- Generous Up to 8-12 weeks paid parental leave, based on role eligibility.
