Claims System Developer

We’re looking for a Claims System Developer to play a critical role in enhancing and modernizing claims administration capabilities. You’ll work at the intersection of technology and claims operations, building and optimizing systems that support accurate, scalable, and efficient claims processing.

This is a hands-on Developer/Technical Administrator role, suited to someone who understands the full claims lifecycle, can navigate complex claims platforms, and is comfortable translating operational needs into technical solutions.

Key Responsibilities:

• Design, develop, and enhance functionality within the claims administration platform
• Configure and customize systems to support evolving claims workflows and business rules
• Contribute to system upgrades, new feature development, and platform improvements
• Build and refine rules-based adjudication logic, including auto-adjudication workflows
• Support end-to-end claims lifecycle functionality, from intake through payment and reconciliation
• Improve processing accuracy, efficiency, and scalability across claims operations
• Work with EDI transactions (837, 835) including mapping, validation, and troubleshooting
• Support data integrity and system integrations across claims, eligibility, and benefits platforms
• Analyze and resolve data discrepancies impacting claims outcomes
• Diagnose and resolve system issues impacting claims processing or data accuracy
• Identify performance bottlenecks and recommend scalable solutions
• Work closely with claims, operations, and product teams to gather requirements and improve workflows
• Translate business needs into technical solutions within the claims platform
• Provide subject matter expertise on claims systems and processing logic
• Maintain clear documentation of system configurations, enhancements, and workflows

Skilled Needed:

• Hands-on experience with claims administration systems (healthcare, insurance, or TPA environments)
• Strong understanding of the claims lifecycle, including adjudication and benefits processing
• Experience building or supporting rules-based or automated claims processing
• Familiarity with EDI transactions (837/835) and data mapping/troubleshooting
• Ability to work across both technical and operational stakeholders
• Strong analytical, problem-solving, and documentation skills

To be considered for the role please apply online or email an updated Resume to William Barclay at Oliver James – [email protected]