Healthcare Claims Manager

Overview

Who We Are

Ready to create a healthier world? We are ready for you! Personify Health is on a mission to simplify and personalize the health experience to improve health and reduce costs for companies and their people. At Personify Health, we believe in offering total rewards, flexible opportunities, and a diverse inclusive community, where every voice matters. Together, we’re shaping a healthier, more engaged future.

 

Responsibilities

Ready to Architect the Data Foundation That Powers Healthcare Excellence?

We're seeking a strategic, technically adept professional who can lead the end-to-end process of ingesting healthcare claims data from multiple carriers into our enterprise systems. As our Manager of Healthcare Claims Ingestion & Data Integration, you'll serve as the critical bridge between carriers, internal teams, and data platforms, ensuring accurate, timely, and compliant claims ingestion that supports client-facing services.

 

What makes this role different:

✓ Strategic carrier partnerships: Serve as primary liaison with healthcare carriers (medical, PBM, vision, dental) to establish and maintain data exchange relationships

✓ Technical leadership: Utilize SQL and transformation logic to diagnose root causes, correct data anomalies, and ensure accurate downstream processing

✓ Cross-functional impact: Collaborate with Implementation, Account Management, Data Engineering, and Operations teams to support enterprise-wide data needs

✓ Quality excellence: Implement robust data validation, reconciliation, and quality control processes ensuring data integrity across all platforms

What You'll Actually Do

Lead carrier engagement: Serve as primary liaison with healthcare carriers to establish and maintain data exchange partnerships while communicating and enforcing universal data specifications.

Manage claims ingestion: Analyze inbound healthcare claims data feeds to identify and triage validation or data quality issues while utilizing SQL and transformation logic for diagnosis and correction.

Optimize data mapping: Manage mapping of carrier-specific data fields into company's universal data model while streamlining validation workflows to quickly detect and correct discrepancies.

Ensure system integration: Verify claims data is accurately processed and routed to all relevant internal systems including client servicing platforms, analytics tools, and operational dashboards.

Implement quality controls: Execute robust data validation, reconciliation, and quality control processes while monitoring ingestion performance and proactively resolving discrepancies or delays.

Provide strategic leadership: Develop and mentor entry-level integration team members while executing strategic plans to scale ingestion capabilities and improve operational efficiency.

Maintain comprehensive documentation: Create and maintain requirement documentation including business rules, file mapping, and transformation process specifications for all inbound claims files.

Qualifications

What You Bring to Our Mission

The educational foundation:

• Bachelor's or Master's degree in Health Informatics, Information Systems, Business/Statistics/Information Science, or related field
• 5+ years experience in healthcare data integration, claims processing, or payer-provider data exchange

The technical expertise:

• Strong understanding of healthcare claims formats (EDI 837, NCPDP, proprietary formats) and wide variety of claims formats and coding standards (CPT, ICD, DRG)
• Strong SQL skills with ability to write and tune complex queries against large-scale datasets
• Proven experience managing external partnerships and internal cross-functional teams
• Familiarity with data warehousing, ETL tools, and cloud-based data platforms is plus

The strategic competencies:

• Data architecture mastery: Design and optimize data models to support scalable ingestion and integration of healthcare claims data
• Schema translation expertise: Translate complex or varying carrier-specific schemas into normalized structures aligned with enterprise data standards
• Cross-functional collaboration: Work effectively with carriers and internal departments to ensure claims data is structured for downstream applications
• Governance excellence: Strong understanding of data governance, master data management (MDM), and data quality fram