Data Mining Analyst
At a glance
Mid-level Data Analysis & BI role at Machinify. United States · full-time · $80,000–$90,000 base.
dataroles summary, based on the employer's posting.
What you'll do
- Examine claims both before and after payment, applying contract and reimbursement knowledge to spot inaccurate payouts
- Compare provider agreements with payer rules, contracted rates and payment approaches
- Turn reimbursement requirements into analytical methods and automated workflows with engineering and data science colleagues
- Use claim-level information to find why overpayments or wrongful denials happened, then propose corrections
- Check concept quality and accuracy, and help improve related processes
What you bring
- At least two years mining healthcare data or editing claims for a provider, insurer or vendor
- You understand provider contract terms, including rate designs, carve-outs and payment calculations
- You know how CMS and commercial payer claims are coded, billed, processed and paid
- You can connect payment anomalies to underlying causes and identify corrective opportunities
Who this fits
This hands-on role suits someone who enjoys investigating claims and translating reimbursement expertise into structured concepts with technical teams. You can work from anywhere in the US.
From the employer
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. 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.
Machinify is seeking an Analyst to help develop and refinement new reimbursement and payment integrity concepts. This is a hands-on healthcare domain role, not a technical or engineering position. The ideal candidate understands reimbursement logic, payment policies, and provider contracts in depth — and can translate that expertise into clear, structured concepts that inform analytics and automation efforts.
You will 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:- Lead pre and post-pay claim reviews to identify inaccurate payments using reimbursement and contract expertise.
- Analyze and interpret provider contracts to ensure payments align with negotiated terms, methodologies, and payer rules.
- Collaborate closely with engineering and data science teams to translate business and reimbursement logic into analytical and automation frameworks.
- 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.
- 2+ years of experience in healthcare data mining or claims editing on the provider, payer, or vendor side.
- Deep understanding of provider contracts, including rate structures, carve-outs, and reimbursement methodologies.
- Strong knowledge of claims processing, coding, billing, and payment logic across 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 close collaboration with technical teams to guide implementation of business logic.
- Self-directed, detail-oriented, and adaptable to a fast-paced, growing environment.
- Work from anywhere in the US! Machinify is digital-first.
- Top Medical/Dental/Vision offerings
- FSA/HSA
- 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
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