Senior Healthcare Reclamation Analyst

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: $54,000 - $64,000

The Sr. Healthcare Reclamation Analyst reviews and analyzes large volumes of client data and payer correspondence, investigates coverage to determine eligibility and primacy, and gathers and interprets explanation of benefits and payer feedback in order to recover funds for clients who have paid in error.  Additionally, the senior role leverages subject matter expertise and experience to perform a variety of activities and projects such as supporting team development, handling client requests, analysis, and reporting, as well as initiatives developing and continuous improvement of operational infrastructure and initiating new client programs.

Key Responsibilities

• Leverage knowledge and expertise in COB/TPL/Recovery to gather and review in-house data with payer correspondence to determine proper order of benefits and resolve primacy issues.
• Successfully solve complex data or record discrepancies and/or issues.
• Communicate effectively with carriers to determine primacy; answer questions and/or provide information that will bring to successful payment or other appropriate account action.
• Contact Healthcare Insurance carriers regarding claim responses.
• Educate Healthcare Insurance carriers on the Coordination of Benefits rules and appropriately responds to complex questions.
• Analyze and understand written communication from insurance companies including explanation of benefits (EOBs).
• Actively collaborate with internal groups and/or functions with gathering and interpretation of the claims billing process and denial management for continuous improvement in workflow and systems.
• Actively contributes to continuous improvement and development for new client programs of scripts, guidelines, and other tools provided to have professional conversations with Healthcare Insurance carriers and/or providers.
• Effectively works assigned inventories to consistently exceed productivity metrics assigned by management, while also performing other duties of the senior analyst role that support the broader group.
• Leverage knowledge and expertise to research various scenarios that will bring to successful resolution and payment (e.g., eligibility research and claims appeals) and consistently resolve the most complex eligibility discrepancies and questions.
• Initiate applicable action and documentation based upon insurance carriers selected.
• Update company systems with clear and accurate information such as point of contact, updated demographic information, notes from contact from outbound and inbound calls and/or attempts, as well as account status updates as applicable.
• Supports management with inventory assessment and distribution to team members.
• Provide ongoing feedback to Management and Analytics Teams to further the enhancement of our products and services, workflows, and documentation.
• Assist Management on assigned projects (including ramping up new client programs), client requests, regular reporting, data analysis and reconciliations, testing, and analytics reviews as required by the business.
• Serve as a mentor/subject matter expert to representative and junior analyst team members to maximize their potential throughout their development process and leads by example.
• Conducts quality reviews on work performed by team representatives and analysts on the team as requested by management. 
• Supports team training activities and contributes to development and enhancement of training materials and tools.
• Leads and contributes to ad-hoc projects and initiatives and establishing best practices.
• Consistently maintains regular good attendance, demonstrates professionalism, sound judgment, and good decision making.
• 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.
• Consistently achieves or ex