Senior Healthcare Data Analyst: AI-Driven Claims Insights

Rawlings Company; United States; On-site; USD 140,000 - 170,000; Full time

Benefits offered by this job

Work from anywhere in the US

Medical/Dental/Vision for employees

Unlimited PTO

Equity

401(k) including employer match

Job summary

Machinify, a leading healthcare data company, is seeking a Senior Healthcare Data Analyst to translate raw claims feeds into trusted models and drive payment integrity insights. You will audit data pipelines, implement transformations for 837 EDI/UB-04/CMS-1500 formats, and apply ICD-10-CM/PCS, CPT, HCPCS codes within a scalable analytics platform.

Ideal candidates will have 5+ years of healthcare claims experience, strong SQL skills, and the ability to collaborate with engineers, clinicians,

Qualifications

• Bachelor's degree or higher in a relevant field.
• 5+ years working directly with healthcare claims data (837 EDI, encounter data, medical billing).
• Deep knowledge of claim types and coding systems (ICD-10-CM/PCS, CPT, HCPCS).
• Hands-on payment integrity experience (overpayment detection, COB, billing edits).
• CMS regulations and payer guidelines related to adjudication and payment policy.

Responsibilities

• Design and implement data transformations converting raw claims into canonical models.
• Write SQL and Spark SQL queries to validate pipeline output end-to-end.
• Develop deep platform knowledge from data ingestion through claims adjudication.
• Identify overpayment patterns and payer policy implications.
• Drive AI adoption and automate repetitive analysis tasks.

Skills

Advanced SQL

Data modeling

Stakeholder communication

Self-starter/ownership

Problem solving

Education

Bachelor's degree in Business, Computer Science, Health Informatics, or related field

Tools

Spark SQL

Job description

Machinify, a leading healthcare data company, is seeking a Senior Healthcare Data Analyst to translate raw claims feeds into trusted models and drive payment integrity insights. You will audit data pipelines, implement transformations for 837 EDI/UB-04/CMS-1500 formats, and apply ICD-10-CM/PCS, CPT, HCPCS codes within a scalable analytics platform.

Ideal candidates will have 5+ years of healthcare claims experience, strong SQL skills, and the ability to collaborate with engineers, clinicians,