Intelligent Claims Resolution Specialist

4 days ago

Gurgaon, Haryana, India beBeeClaims Full time US$ 1,00,000 - US$ 1,50,000
Intelligent Claims Resolution Specialist

We are seeking a skilled professional to orchestrate Large Language Models (LLMs) and Small Language Models (SLMs) that optimize revenue cycle processes, minimize Accounts Receivable (AR) dollars, and improve claim resolution efficiency.

About the Role:

The ideal candidate will work closely with healthcare experts and engineers to design and implement AI ML models for claims prioritization, denial resolution, and revenue cycle optimization. The successful applicant will develop and fine-tune LLMs and SLMs to enhance automation in claims management workflows.

Responsibilities:
  • Design and implement AI ML models for claims prioritization, denial resolution, and revenue cycle optimization.
  • Develop and fine-tune LLMs and SLMs to enhance automation in claims management workflows.
  • Preprocess and structure claims data for effective model training.
  • Deploy, manage, and scale AI models using cloud services.
  • Continuously monitor model performance, retrain, and refine algorithms to improve accuracy and operational efficiency.
  • Ensure compliance with HIPAA, PHI security standards, and healthcare data privacy regulations.
  • Document technical solutions and create best practices for scalable AI-driven claims management.
Requirements:
  • degree in computer science, AI/ML, Engineering, or a related field.
  • 3 years of experience in AI/ML engineering, preferably in healthcare claims automation.
  • Proficiency in Python, with strong knowledge of LLMs, NLP, and text analytics for claims processing.
  • Experience with cloud-based machine learning platforms.
  • Familiarity with healthcare claims data formats, EDI 837, 835, and revenue cycle processes.
  • Strong analytical, problem-solving, and teamwork skills.
Benefits:
  • Competitive salary package.
  • Opportunity to contribute to innovative AI solutions in the healthcare industry.
  • Dynamic and collaborative work environment.
  • Opportunities for continuous learning and professional growth.

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