Lyric - Clarity in motion.

• Process medical insurance claim overpayments identified through data mining efforts. • Post recoveries, process adjustments, and offsets, and conduct collection activities for refund checks. • Validate overpayments based on policy instructions and claim coding details. • Maintain a library with instructions for validating specific audit concepts and client-specific rules. • Assist in identifying process and audit concept improvements. • Perform data entry, tracking correspondence, and generating letters. • Collaborate with internal teams to resolve discrepancies or provider questions efficiently. • Review claims for missing or incomplete information, calculate payment, or validate identified overpayments. • Manage outstanding accounts receivable, contact providers to collect payment, and identify unpaid account issues. • Maintain legal compliance by adhering to company and client policies as well as state and federal regulations. • Prepare basic reports by collecting and analyzing information.

• Design, develop, and execute test cases for projects of varying complexity • Analyze client and system requirements, clarify ambiguities, and create detailed test designs • Utilize both manual and automated testing techniques • Develop and maintain reusable test artifacts • Conduct thorough test result reviews to ensure accuracy • Act as a consultative partner to customers • Facilitate discovery sessions and workshops • Participate in requirement and design review sessions • Strive to prevent unnecessary challenges by promoting comprehensive requirements gathering • Identify gaps and inconsistencies in requirements early • Provide input into QA strategy improvements • Serve as a subject matter expert for special projects • Ensure seamless 100% PTO coverage • Monitor project and service delivery outcomes • Lead change management efforts • Proactively identify opportunities to add value

• Advises on ClaimsXten clinical content and rules/policies, including documentation requirements, client customizations, and configuration options. • Leads client-facing discussions, serving as subject matter expert explaining ClaimsXten edit logic, content sourcing, rationale and expected outcomes to organizations that utilize Lyric’s edits for pre-payment editing. • Maintains working understanding of Lyric’s product behavior to explain and troubleshoot edit outcomes (e.g., triggers, rule logic, content overlaps, configuration dependencies). • Reviews data analytics to assess impacts to content changes and new CPT/HCPCS/ICD10CM code set updates. • Supports client escalations related to Pre-Payment edits, including analysis of scenarios and articulation of recommended resolution paths. • Serves as Clinical liaison across Clinical Operations, Client Success, and other cross functional Lyric teams to increase value of ClaimsXten edits to clients.

• Architect and drive the strategic vision for AI/ML platforms that power document ingestion, understanding, and extraction across multiple product teams and use cases. • Establish organization-wide frameworks and standards for dataset quality, ML validation methodologies, and model verification processes that ensure healthcare-grade safety and compliance. • Define core ML infrastructure for LLM operations, including model serving platforms, fine-tuning pipelines, and generative AI systems that enable teams to build reliable document understanding applications at scale. • Lead the technical architecture for production capabilities. • Build and optimize the core RAG infrastructure, vector database architecture, and LLM integration patterns that enable efficient retrieval and structured output generation for downstream systems. • Drive cross-functional technical strategy, partnering with product, clinical, and engineering leadership to align multi-quarter ML roadmaps with business requirements and regulatory compliance. • Mentor junior/mid AI/ML engineers across distributed teams, establish best practices for model training, evaluation, and monitoring, and define ML engineering standards that scale across the organization. • Stay abreast of the latest advancements in generative AI and lead technical evaluation and adoption of cutting-edge techniques that provide measurable business value.

• Leads the end-to-end design and development of software solutions, including back-end and integration components • Collaborates closely with product managers, designers, and other engineers to define technical requirements, scope, and deliverables • Provides technical leadership and guidance to a team of engineers, fostering a culture of innovation, collaboration, and technical excellence • Drives architectural decisions and ensures adherence to coding standards, best practices, and software quality principles • Develops and maintains application frameworks, libraries, and reusable components to streamline development processes • Collaborates with cross-functional teams to identify and address technical challenges, performance optimizations, and scalability concerns • Mentors and guides engineers on technical design, coding practices, and system architecture, promoting professional growth and skill development. • Stays up-to-date with emerging technologies, frameworks, and industry trends, driving the adoption of new tools and methodologies • Conducts code reviews and provides constructive feedback to ensure code quality, maintainability, and system stability • Act as a technical evangelist, representing the Company in industry events, conferences, and technical communities, and sharing knowledge and insights.

• Ship modernization work at a pace that surprises people • Use AI agents (Cursor, Claude Code, Codex) to blow through framework upgrades, refactors, API extraction, test scaffolding, and documentation • Build reusable playbooks the team can actually follow • Modernize a real .NET + SQL Server stack into something you'd be proud of • Build with security and privacy as defaults, not afterthoughts • Work with analysts, stakeholders, and other engineers to turn business problems into working software

• Plans, conducts, and directs the analysis of both internal and external business problems to be solved with automated systems. • Works with clients to develop analyses for the purpose of pre-sale software evaluation, claims editing optimization, or ad hoc reporting. • Leads analytic engagements for a portfolio of clients, in conjunction with internal business intelligence to design analyses to meet customer needs. • Facilitates all pieces of external and internal analytic engagements, such as data diagnostic review, data mapping, edit analysis using Excel and SQL, and presentations using PowerPoint. • Executes complex analyses to aid in reporting and interpretation of analytical findings to build a customer solution roadmap and achieve maximum value from the ClaimsXten Portfolio suite of products and services. • Compiles findings into a clear, concise, and actionable deliverable. • Presents findings to customers and completes necessary follow-up analysis. • Manages customer portfolio of analytic engagements and deliverables, responding to any ad hoc requests on an ongoing basis. • Manage and prioritize multiple projects simultaneously and adapt to rapidly changing schedules, priorities, and workflows.

• Assist in designing and developing agentic AI workflows to automate Corporate IT processes • Build integrations across enterprise platforms (HRIS, ITSM, identity, device management, finance systems) • Support development of AI-powered agents for ticket triage, request fulfillment, and knowledge retrieval • Collaborate with Helpdesk, Enterprise Applications, and Systems teams to identify automation opportunities • Develop scripts (Python, PowerShell, or similar) to support workflow execution • Document workflows, architecture diagrams, and operational procedures

• Supports the Data Mining (DM) program by independently investigating moderate-to-complex payment errors resulting from incorrect processing of payment policies, contract terms, billing, and/or coding to prevent and recover improper claim payments. • Performs hands-on casework in a high-volume environment, including investigation, documentation, and system updates, while applying advanced analytical skills to interpret claims and reimbursement data, identify trends and false positives, and contribute to concept development and process improvements that enhance accuracy and operational performance within the DM program. • Operates with increased autonomy, applying judgment to resolve non-routine scenarios, and contributes to improving workflows, logic, and data quality, while collaborating cross-functionally to support scalable payment integrity outcomes. • Review, prioritize, and independently work assigned DM leads (automated and manual), including moderate-to-complex and high-dollar cases, to determine verification steps and next actions. • Investigate and validate payment terms (Inpatient, Outpatient, Professional, Ancillary) using internal systems, payer portals, contracts, and other approved data sources. • Analyze claim inventory from identification to resolution. • Develop concept overviews and analysis. • Compile sample claims and supporting documentation for Client review and approval. • Maintain a library that includes instructions for validating specific audit concepts. • Create clear, detailed, and accurate case notes that capture verification steps, evidence, and outcomes in internal tools to support audits and downstream recovery/reprocessing.

• Investigation and verification • Review, prioritize, and work assigned COB leads (automated and manual) to determine required verification steps and next actions. • Investigate and validate coverage details (payer, plan type, subscriber relationship, policy indicators, effective/termination dates) using internal systems, payer portals, EOBs/claim responses, and other approved data sources. • Apply COB rules and guidelines, including CMS and NAIC guidance as applicable, to determine the correct order of liability and document the rationale for the primacy determination. • Outreach, documentation, and system updates • Contact insurance carriers, employers, clearinghouses, providers, and other third parties as needed to confirm or clarify coverage information and obtain supporting evidence. • Create clear, detailed, and accurate case notes that capture verification steps, evidence, and outcomes in internal tools to support audits and downstream recovery/reprocessing. • Update eligibility/COB records and coordination rules based on verified information and confirm updates are applied correctly to reduce downstream adjudication errors and abrasion. • Payment integrity support & Operational excellence • Provide validated COB outcomes that support downstream payment integrity activities (recovery, reprocessing, adjustments) with minimal rework. • Prepare and evaluate documentation needed for inquiries, disputes, and appeals related to determinations, as assigned. • Meet or exceed established productivity, turnaround time, and quality/audit standards while managing a high-volume case queue. • Analytical contribution • Track outcomes and error categories, identify root causes of recurring COB issues and false positives, and recommend opportunities to streamline research, improve data quality, and reduce incorrect payments. • Use Excel and other tools to support ad hoc analysis (e.g., trend review, inventory quality checks, and performance insights); partner with stakeholders to clarify requirements and improve workflows. • Reconcile discrepancies across sources (eligibility feeds, member/group data, claim history, and third-party responses) and drive cases to a clear, audit-ready determination.