Sr. Claims Integrity & Quality Analyst, Health Plan Operations

About Curative

Curative is building the future of health insurance with a first-of-its-kind employer-based plan designed to remove financial barriers and make care truly accessible: one monthly premium with $0 copays and $0 deductibles*. Backed by our recent $150M in Series B funding and valuation at $1.275B Curative is scaling rapidly and investing in AI-powered service deeper member engagement and a smart network designed for todays workforce.

Our north star guides everything we do: healthcare only works when people can actually use it. That belief drives every decision we make: from how we design our plan support our members to how we collaborate as a team.

If you want to do meaningful work with a team that moves fast experiments boldly and cares deeply Curative is the place to do it. Were growing fast and looking for teammates who want to help transform health insurance for the better.

Reimagining health insurance
At Curative were 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. As we continue to scale nationally were looking for a Senior Claims Integrity & Quality Analyst who is passionate about improving claims accuracy reducing operational friction and helping build a modern technology-enabled claims organization. This is not a traditional audit role. Youll help design and execute the quality framework that drives payment accuracy regulatory compliance automation and operational excellence across our claims ecosystem. Youll partner with Claims Operations Configuration Product Compliance and Technology teams to identify root causes eliminate defects and improve auto-adjudication performance. If you enjoy solving complex problems improving systems and influencing operational outcomes wed love to meet you.

Job Summary:
This key role is responsible for conducting in-depth analysis of high-dollar and complex claims including IDRs and Balance Billing scenarios to ensure the supporting medical documentation validates the billing received for payment. This role is critical in driving solutions for first pass claims payment accuracy. Collaborate with payment integrity to ensure compliance with commercial health plan policies contract agreements and industry regulations.

How you will make an impact:

• Conduct in-depth audits and clinical reviews of professional institutional ancillary and high-dollar claims focusing on adjudication accuracy benefit application pricing and coding (ICD-10 CPT/HCPCS DRG).
• Utilize advanced coding expertise and workflow systems to substantiate audit findings generate recoverable claims and investigate potential fraud and utilization patterns.
• Drive operational excellence by validating claims configuration reimbursement methodologies and processing logic.
• 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.
• Identify trends defects and operational risks impacting claims quality. Develop reports and present findings and recommendations to operational leadership to drive corrective actions and improvement opportunities.

Minimum Requirements:

• BA/BS degree in a related field
• Minimum 5 years of experience in healthcare claims auditing coding auditing or formal quality assurance program experience. Broad knowledge of provider billing guidelines payer reimbursement policies medical policy guidelines and commercial insurance plans.
• Requires at least one of the following current certifications from AAPC or AHIMA: RHIA RHIT CCS CIC or CPC.
• Minimum 5 years of experience working with ICD-10CM MS-DRG AP-DRG and APR-DRG coding standards.
• Experience identifying root causes and driving corrective actions.
• Strong analytical and investigative skills.

Preferred Skills Capabilities and Experience:

• Health plan or payer-side experience
• Experience with claims configuration validation
• Experience supporting automation initiatives
• Experience working in a high-growth environment
• Clinical nursing with exposure to hospital bill auditing.
• Unrestricted Registered Nurse (RN) license.
• Proficiency in Google Workspace and experience with audit tracking systems and data analytics tools (Snowflake Streamlit Claude).

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 (Rula Televero Two Chairs Recovery Unplugged)
  • 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
• Flexible work options: remote and in-person opportunities
• Generous PTO policy plus 11 paid annual company holidays
• 401K for full-time employees
• Generous Up to 812 weeks paid parental leave based on role eligibility.