Claims AI Business Analyst IV

CareSource is a healthcare management services company, and they are seeking a Claims AI Business Analyst IV to drive process transformation initiatives across Claims Operations. This role involves leveraging AI and automation to enhance efficiency and quality, while managing the entire lifecycle of initiatives from intake to implementation.

Responsibilities:

• 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

Requirements:

• 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
• 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
• 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