Operations Automation Specialist
Employerdirect Health Care · Dallas, TX - Hybrid (3x in office/week); New York, NY - Hybrid (3x in office/week)
About this role
**Operations Automation Specialist — Lantern** **About Lantern** Lantern is a specialty care platform connecting people with the best care when they need it most. Lantern curates a Network of Excellence of top specialists for surgery, cancer care, infusions, and more—paired with a dedicated care team (Care Advocates and nurses) throughout the care journey. Lantern is trusted by the nation’s largest employers and supports more than 6 million members. Learn more at lanterncare.com. --- ## Job Overview As an **Operations Automation Specialist**, you’ll start by **personally resolving provider inquiries**—then build the tools and AI-assisted workflows that make one-by-one manual resolution unnecessary. Today, answering provider questions requires detailed manual auditing across multiple systems. This role focuses on combining existing data sources with modern AI tools to scale accurate, faster resolutions. This is a **technical role in the lowercase-t sense**: you don’t need to arrive as a software engineer or data analyst. You do need strong instincts for spotting patterns and automating them away—plus the willingness to learn new tools (including SQL and AI tooling) largely on your own. --- ## What You’ll Do ### Resolve, hands-on - Work a live queue of provider claims inquiries (status, payment amount, denial/rejection questions, aged-claim batches) through accurate resolution - Audit individual claims across systems to confirm they were submitted, validated, priced, and paid correctly - Escalate genuine pricing or appeals determinations and document learnings so patterns can be automated ### Understand the problem at scale - Query claims, pricing, and provider data using **SQL** (including tools like **Databricks**) to characterize inquiry volume, root causes, and cost to serve - Distinguish inquiries caused by real payment problems vs. inquiries caused by providers lacking visibility (different fixes required) ### Build the fix - Design and build **AI-assisted workflows** to triage inquiries, retrieve claim/contract facts, validate payments, and draft provider-ready responses - Build in **verification** (correctness matters—confident wrong answers are worse than slower correct ones) - Test against real ticket volume, measure impact honestly, and iterate ### Push upstream - Address root causes behind categories of inquiries (deferred claims, ingestion errors, notification gaps), not just symptoms - Contribute to provider self-service so fewer questions reach the team --- ## About You You have the business and communication fundamentals to do the work well today, and the drive to build automation for tomorrow. ### Core - Communicate clearly with providers and internal stakeholders (real conversations, plain-language explanations) - Understand the business/financial side of how claims and payments move (not purely technical) - Desire to expand **SQL** skills and use **Python + AI tools** (including agentic coding tools like Claude Code) to improve how work gets done - Strong correctness mindset: ask “how would I know if this were wrong?” and build checks - Comfortable with ambiguity and systems that don’t always agree - Start by doing the resolution work yourself—automation is only trustworthy when you’ve done the process ### Strongly preferred - Hands-on SQL and/or Python experience, plus real fluency with modern AI tools (with something you’ve built) - 1+ year of work experience (internship/part-time/full-time), especially
Listing freshness
CronJobs last confirmed this listing 1h ago. If its source stops confirming the opening for seven days, this page is removed from active inventory.