United States onlyMachinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plan clients across the country. Deployed by over 85 health plans, including many of the top 20, and representing more than 270 million lives, Machinify brings together a fully configurable and content-rich, AI-powered platform along with best-in-class expertise. We’re constantly reimagining what’s possible in our industry, creating disruptively simple, powerfully clear ways to maximize financial outcomes and drive down healthcare costs.
About the Role
Machinify is seeking aSenior Analystto lead the development and refinement of new reimbursement and payment integrity concepts. This is ahands-on healthcare domain role, not a technical or engineering position. The ideal candidate understandsreimbursement logic, payment policies, and provider contractsin depth — and can translate that expertise into clear, structured concepts that inform analytics and automation efforts.
You’ll be focused on discovering where and why payment errors occur, designing methods to detect and prevent them, and partnering with technical teams to operationalize your findings. This role is ideal for someone who loves digging into claims data, identifying systemic payment issues, and shaping how technology solutions capture real-world reimbursement logic.
What You’ll Do
· Leadpre and post-pay claim reviewsto identify inaccurate payments using reimbursement and contract expertise.
· Analyze and interpretprovider contractsto ensure payments align with negotiated terms, methodologies, and payer rules.
· Collaborate closely withengineering and data science teamsto translate business and reimbursement logic into analytical and automation frameworks.
· Research and documentemerging reimbursement and contract patterns, coverage rules, and billing practices to inform concept development.
· Translate complex reimbursement and contract scenarios intostructured rules and business logicfor implementation.
· Analyze claim-level data to pinpoint root causes of overpayments or incorrect denials and recommend corrective approaches.
· Maintain expertise on CMS and commercial payer reimbursement guidelines.
· Support quality review, concept validation, and process improvement initiatives.
Required Qualifications
·5+ yearsexperience in healthcare data mining or claims editing on the provider, payer, or vendor side
· Deep understanding ofprovider contracts, including rate structures, carve-outs, and reimbursement methodologies.
· Strong knowledge ofclaims processing, coding, billing, and payment logicacross CMS and commercial payers.
· Proven ability to identify improper payment patterns, root causes, and opportunities for correction.
· Strong investigative and deductive reasoning skills; able to connect policy, data, and contractual details.
· Comfortable working in closecollaboration with technical teamsto guide implementation of business logic.
· Self-directed, detail-oriented, and adaptable to afast-paced, growing environment.
Preferred Qualifications
· Coding or billing certifications.
· Working proficiency inSQLfor data exploration and validation.
· Prior work incross-functional R&D or innovation teamsfocused on healthcare payment integrity.
Machinify is seeking aSenior Analystto lead the development and refinement of new reimbursement and payment integrity concepts. This is ahands-on healthcare domain role, not a technical or engineering position. The ideal candidate understandsreimbursement logic, payment policies, and provider contractsin depth — and can translate that expertise into clear, structured concepts that inform analytics and automation efforts.
You’ll be focused on discovering where and why payment errors occur, designing methods to detect and prevent them, and partnering with technical teams to operationalize your findings. This role is ideal for someone who loves digging into claims data, identifying systemic payment issues, and shaping how technology solutions capture real-world reimbursement logic.
What You’ll Do
· Leadpre and post-pay claim reviewsto identify inaccurate payments using reimbursement and contract expertise.
· Analyze and interpretprovider contractsto ensure payments align with negotiated terms, methodologies, and payer rules.
· Collaborate closely withengineering and data science teamsto translate business and reimbursement logic into analytical and automation frameworks.
· Research and documentemerging reimbursement and contract patterns, coverage rules, and billing practices to inform concept development.
· Translate complex reimbursement and contract scenarios intostructured rules and business logicfor implementation.
· Analyze claim-level data to pinpoint root causes of overpayments or incorrect denials and recommend corrective approaches.
· Maintain expertise on CMS and commercial payer reimbursement guidelines.
· Support quality review, concept validation, and process improvement initiatives.
Required Qualifications
·5+ yearsexperience in healthcare data mining or claims editing on the provider, payer, or vendor side
· Deep understanding ofprovider contracts, including rate structures, carve-outs, and reimbursement methodologies.
· Strong knowledge ofclaims processing, coding, billing, and payment logicacross CMS and commercial payers.
· Proven ability to identify improper payment patterns, root causes, and opportunities for correction.
· Strong investigative and deductive reasoning skills; able to connect policy, data, and contractual details.
· Comfortable working in closecollaboration with technical teamsto guide implementation of business logic.
· Self-directed, detail-oriented, and adaptable to afast-paced, growing environment.
Preferred Qualifications
· Coding or billing certifications.
· Working proficiency inSQLfor data exploration and validation.
· Prior work incross-functional R&D or innovation teamsfocused on healthcare payment integrity.
What We Offer:
- Work from anywhere in the US! Machinify is digital-first.
- Top Medical/Dental/Vision offerings
- FSA/HSA
- Solid PTO program
- Tuition reimbursement
- Competitive salary, 401(k) with company match
- Additional health and wellness benefits and perks
- Flexible and trusting environment where you’ll feel empowered to do your best work
Equal Employment Opportunity at Machinify
We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender, gender identity or expression, or veteran status. We are proud to be an equal opportunity workplace. Machinify is an employment at will employer. We participate in E-Verify as required by applicable law. In accordance with applicable state laws, we do not inquire about salary history during the recruitment process. If you require a reasonable accommodation to complete any part of the application or recruitment process, please let our recruiters know. See our Candidate Privacy Notice at: https://www.machinify.com/candidate-privacy-notice/
