Senior Data Mining Analyst

Machinify

. Lead pre and post-pay claim reviews to identify inaccurate payments using reimbursement and contract expertise.

Posted 11/1/2026full-timeRemote • United StatesSenior💰 $125,000 - $135,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Expertise in analyzing provider contracts and reimbursement methodologies, with a strong focus on claims processing and payment logic. Proven ability to collaborate with technical teams to implement business logic and improve healthcare payment integrity.

Highest-signal resume keywords

Healthcare Data MiningClaims EditingProvider Contracts AnalysisClaims Processing KnowledgeSQL Proficiency

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims ProcessingReimbursement MethodologiesData AnalysisContract InterpretationPayment LogicRoot Cause AnalysisBilling PracticesCodingData ValidationAutomation Frameworks

Soft Skills

Investigative SkillsDeductive ReasoningCollaborationDetail-OrientedAdaptability

Certifications & Qualifications

CPCCCS

Industry Keywords

CMS GuidelinesCommercial Payer RulesPayment IntegrityHealthcare PaymentsContract Patterns

Tech Stack

Tools & technologies

SQL

About the role

Key responsibilities & impact

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.
Research and document emerging reimbursement and contract patterns, coverage rules, and billing practices to inform concept development.
Translate complex reimbursement and contract scenarios into structured rules and business logic for implementation.
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.

Requirements

What you’ll need

5+ 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.
Coding certification (e.g., CPC, CCS, or equivalent) preferred.
Working proficiency in SQL for data exploration and validation preferred.
Prior experience in cross-functional R&D or innovation teams focused on healthcare payment integrity preferred.

Benefits

Comp & perks

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