Teams at SmartLight Analytics

Leads carrier engagement and payment integrity operations, overseeing carrier performance, satisfaction, quality, compliance, payment processes, and service delivery. Builds strategic carrier relationships, manages escalations, facilitates business reviews, analyzes claims and billing data, and drives cross-functional process improvements. The role develops service standards, identifies performance gaps, strengthens communication, and partners with IT and internal teams to improve tools, workflows, operational efficiency, and carrier experiences.

Build and own automation-first QA across internal tools, carrier APIs, and customer portals. Design Playwright-based regression suites, integrate tests into CI/CD, apply AI testing tools, isolate defects, prioritize risk-based coverage, serve as a release quality gate, and document QA practices and compliance evidence. Partner with Engineering, Product, and Data Platforms in a fully remote role.

Analyzes high-cost hospital claims, itemized bills, coding, DRG assignments, contracts, and stop-loss provisions to identify billing errors and overpayments. Prepares findings, savings reports, and appeals while negotiating adjustments with TPAs, carriers, and claims administrators on behalf of ASO clients. Reviews catastrophic claims, supports recovery efforts, tracks disputes, and collaborates with analytics teams to improve claim identification.