Remote Senior Healthcare Data Analyst - AI-Driven Claims

machinifyinc; United States; Remote; USD 140,000 - 170,000; Full time

Benefits offered by this job

Fully remote role

Medical, dental, vision coverage for员工

Unlimited flexible time off

Equity and 401(k) with employer match

Job summary

machinifyinc is seeking a Senior Data Analyst to work on healthcare claims within an AI-driven payment integrity platform. You will translate raw claims feeds into canonical data models and surface insights that improve how health plans audit and adjudicate claims.

The role bridges domain expertise with data engineering, requiring deep healthcare data knowledge and familiarity with modern AI tooling. Fully remote in the US is possible.

Qualifications

• Bachelor's degree in Business, Computer Science, Health Informatics, or a related field.
• 5+ years working directly with healthcare claims data (837 EDI, encounter data, medical billing).
• Deep knowledge of professional and institutional claim types, ICD-10-CM/PCS, CPT, HCPCS, and standard form formats (UB-04, CMS-1500).
• Hands-on payment integrity experience such as overpayment detection, coordination of benefits, billing edits, or claim editing logic.
• Familiarity with CMS regulations and commercial payer guidelines as they apply to claims adjudication and payment policy.
• Advanced SQL proficiency with the ability to write complex analytical queries against large datasets, plus solid understanding of data modeling concepts.

Responsibilities

• Design and implement data transformations that convert raw medical and institutional claims into canonical data models.
• Audit pipelines end-to-end to detect, troubleshoot, and resolve data quality issues.
• Develop working knowledge of the claims adjudication platform for traceable analytical solutions.
• Identify overpayment patterns and billing edit opportunities by applying payer policy and CMS regulations.
• Drive AI-assisted workflows by prompting and iterating with large language models to accelerate analysis.

Skills

Advanced SQL

Spark SQL

Data modeling

Communication

Education

Bachelor's degree

Tools

Spark SQL

Job description

machinifyinc is seeking a Senior Data Analyst to work on healthcare claims within an AI-driven payment integrity platform. You will translate raw claims feeds into canonical data models and surface insights that improve how health plans audit and adjudicate claims.

The role bridges domain expertise with data engineering, requiring deep healthcare data knowledge and familiarity with modern AI tooling. Fully remote in the US is possible.