Sr. HCS Operations Inventory & Quality Analyst (Eligibility)

ABOUT MACHINIFY:

In October 2025, Machinify acquired Performant and we are now part of the Machinify organization.  Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plans. Deployed by over 75 health plans, including many of the top 20, and representing more than 170 million lives, Machinify’s AI operating system, combined with proven expertise, untangles healthcare data to deliver industry-leading speed, quality, and accuracy. We’re reshaping healthcare payment through seamless intelligence. 

ABOUT THE OPPORTUNITY:

Hiring Range: $70,000 - $80,000 Salary

The Sr. HCS Operations Inventory & Quality Analyst (Eligibility), leverages strong knowledge of healthcare eligibility, healthcare claims, eligibility validation practices, Coordination of Benefits and Third-Party Liability (COB/TPL), or Medicare Secondary Payer (MSP), plus strong data analysis and technical skills to support inventory management, process documentation, and production QA process for assigned operations teams in the Eligibility organization.

Key Responsibilities

Essential Duties

• Work closely with the operations teams and data team to ensure inventory is accurately and efficiently distributed/assigned and transferred across teams based upon applicable inventory type workflow and requirements. 

• Conduct auditing of operations team activities on inventory to validate compliance with internal requirements, client contracts, regulatory requirements, and industry quality standards.

• Facilitate communications and collaborate to convey/clarify requirements for inventory data flow based upon client/type/source serving as a liaison between the operations and eligibility & analytics data team.

• Utilize SQL queries (and develop queries as may be needed) and leverage subject matter knowledge, independent judgement, and analytical skills to: 

  • Test data transfer/flow results. 

  • Perform audit activity. 

  • Create and maintain regular internal/external activity and metrics reporting; and 

  • Other support for operations workflow and activity.

• Support payer outreach and EDI teams in the implementation of new EDI connections.

• Conducts a variety of data analysis for intelligent insights using subject matter knowledge, independent judgement, and analytical expertise.

• Mentors operations team and data team on paper and electronic claims processes

• Creates and maintains internal and external reporting as needed.

• Contribute to development and continuous improvement of operational tools, processes and procedures for quality and inventory.

• Provides Supervisors/Management with staff production quality results, as well as any insights for feedback/coaching/training opportunities based upon themes/trends identified to correct areas of quality deficiency and improve overall results.

• May support management with developing or delivering training and tools for skills development to increase capability and effectiveness of analysts.

• Operates under minimal supervision to deliver results aligned with business goals, given guidance in the form of high-level objectives.

• Follows and complies with company, departmental and client program policies, processes, and procedures.

• Responsible for utilizing resources to ensure compliance with client requirements, HIPAA, as well as applicable federal or state regulations.

• Successfully completes, retains, applies, and adheres to content in required training as assigned.

• Correct areas of deficiency and/or areas of opportunity for improvement received from management.

Knowledge, Skills and Abilities Needed

• Knowledge and experience with rules around Medicaid / Medicare COB Other TPL business models and products

• Skilled working with operations systems, tools, and applications for collecting and reporting data as well as identifying trends. 

• Demonstrated ability to work with large volumes of healthcare eligibility and claims data.

• Intermediate skills in MS Excel required.

• Utilization of SQL to run queries. A