Senior Claims Integration Specialist

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 Lead Complex Healthcare Data Integrations That Power Enterprise Excellence?

We're seeking a strategic, technically adept professional who can serve as technical and analytical lead for managing complex healthcare claims data integrations across multiple platforms and partners. As our Senior Claims Integration Specialist, you'll oversee the end-to-end lifecycle of claims ingestion, transformation, and validation while mentoring team members and optimizing integration workflows.

 

What makes this role different:

✓ Technical leadership: Configure, design, and optimize integration workflows while leading root-cause analysis for data anomalies

✓ Mentorship opportunity: Guide junior team members on best practices in claims data management and automation

✓ Cross-platform expertise: Ensure data quality, compliance, and operational stability across Personify's entire claims ecosystem

✓ Strategic impact: Combine technical proficiency with strategic mindset to enhance process efficiency, scalability, and accuracy

 

What You'll Actually Do

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

Manage data ingestion: Collaborate on analysis of inbound healthcare claims data feeds to identify and triage validation or data quality issues using SQL and transformation logic.

Optimize integration workflows: Map carrier-specific data fields into company's universal data model while implementing ingestion processes ensuring data integrity and compliance with internal standards.

Troubleshoot complex issues: Understand and troubleshoot ingestion pipelines, resolving data quality issues and ingestion failures while diagnosing root causes of data anomalies.

Ensure system accuracy: 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.

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

Collaborate strategically: Partner with product, operations, technology, data engineering, and architecture teams to support downstream use cases and optimize database structures.

 

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
• 3+ 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
• Industry standards knowledge: