Senior Data Analyst

Machinify 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. They are seeking a Senior Data Analyst to join their Data Engineering team, focusing on integrating analytical outputs with client workflows and driving AI adoption in data processes.

Responsibilities:

• Collaborate with clients and internal stakeholders to understand payment integrity requirements, document process flows, and integrate analytical outputs with client workflows and downstream adjudication systems
• Develop deep understanding of Machinify's internal processes and how they integrate together — from data ingestion through claims adjudication — ensuring analytical solutions are accurate, traceable, and aligned with business needs
• Actively drive AI adoption: prompt and iterate with LLMs to accelerate analysis, identify processes where AI can replace manual workflows, and contribute to AI-assisted pipeline development
• Write and maintain complex analytical SQL against large-scale claims datasets: window functions, CTEs, multi-table joins, query optimization, and production-quality logic that runs reliably at scale
• Identify and build AI-driven automation workflows that replace or accelerate manual analytical processes — moving from one-off prompts to repeatable, team-shareable tooling
• Design and implement data transformations that convert raw medical and institutional claims into canonical models, applying healthcare coding standards (ICD-10, CPT, HCPCS, UB-04, CMS-1500) throughout
• Drive payment integrity analysis — identify overpayment patterns, coordination of benefits issues, and billing edit opportunities by applying deep knowledge of payer policy, CMS regulations, and provider reimbursement methodologies
• Conduct data quality audits and build monitoring frameworks that surface anomalies before they reach production
• Support onboarding of new client data feeds, ensuring smooth integration with minimal disruption
• Partner with engineers, clinical staff, and product managers to translate complex healthcare requirements into data solutions
• Mentor analysts and engineers on healthcare domain questions — serving as the go-to SME on coding, claims adjudication, and payer policy
• Document transformation logic, data lineage, and analytical methodologies to support knowledge transfer and audit readiness

Requirements:

• 5+ years of data analysis experience and working directly with healthcare claims data
• Deep knowledge of medical claim types (professional and institutional), coding systems (ICD-10-CM/PCS, CPT, HCPCS), and standard form formats (UB-04, CMS-1500)
• Demonstrated experience using LLMs or AI tools to accelerate analytical work — not as a novelty, but as a repeatable part of your workflow
• Expert-level SQL: complex analytical queries, window functions, CTEs, performance tuning against datasets of hundreds of millions of rows
• Hands-on payment integrity experience: overpayment detection, COB, billing edits, or claim editing logic
• Familiarity with CMS regulations and commercial payer guidelines as they apply to claims adjudication and payment policy
• Strong communicator — able to discuss healthcare process and payment logic directly with health plan clients and non-technical stakeholders
• Ability to translate ambiguous business and clinical requirements into precise, well-documented data logic
• Working knowledge of provider reimbursement methodologies — MS-DRG/APR-DRG pricing, fee schedules, per diem, and capitation
• Proficiency with Spark SQL or a comparable distributed query engine — writing and optimizing queries against large-scale data environments is a daily expectation
• Experience with Databricks or a cloud data lakehouse (Delta Lake, Snowflake, BigQuery)
• Background in ETL/ELT pipeline development or close collaboration with data engineers on pipeline design
• Exposure to value-based care arrangements or risk adjustment (HCC coding, RADV)
• Prior experience at a health plan, payment integrity vendor, or healthcare analytics firm