Personify Health

Data Engineer

• Validate HIPAA X12 transaction sets — 837 (I/P/D), 835, 834, 270/271, and 276/277 — to confirm claims, eligibility, and remittance data moves correctly between systems
• Diagnose transaction-level errors in loops, segments, elements, and qualifiers
• Partner with development teams to fix mapping or programming issues
• Investigate and resolve trading partner and vendor transaction problems in production
• Create test plans, test cases, and Companion Guide documentation
• Lead UAT, SIT, and end-to-end testing for vendor onboarding, system enhancements, and HIPAA version upgrades (4010/5010)
• Build and maintain mock 837I/837P claim test data
• Coordinate between trading partners, clients, and internal technical and non-technical teams
• Gather requirements and close the loop on issue resolution
• Log incidents and enhancement requests in JIRA
• Maintain project documentation in Confluence
• Validate ICD-9/ICD-10 and HCPCS coding during claims and EDI testing
• Participate in Agile sprint planning and sprint review

Data Engineer, EDI

Manager

• Lead and develop a team of claims examiners handling high-risk and complex claims
• Coach, guide, and hold team members accountable while driving performance, engagement, and talent development
• Oversee pended, high-dollar, and special-handling claims from start to finish
• Ensure timely and accurate adjudication in line with policies and service standards
• Resolve escalated claim payment problems and discrepancies
• Partner with internal teams on fraud investigations and escalated inquiries
• Coordinate responses to audits, legal requests, insurance complaints, Department of Labor matters, and regulatory inquiries
• Ensure adherence to Medicare, HIPAA, and applicable regulatory standards
• Conduct ongoing reviews of quality, productivity, and documentation requirements
• Identify workflow gaps, standardize procedures, and implement best practices
• Partner with leadership to increase auto-adjudication rates and reduce manual intervention
• Collaborate with IT, legal, compliance, and vendors on system and process improvements
• Support system enhancements, test and implement updates, and optimize EDI processes
• Track accuracy, productivity, and turnaround metrics and provide recommendations to leadership
• Contribute to implementations, RFP support, and project teams to support successful launches

Senior Manager – Healthcare Claims

Claims Specialist

• Review, analyze, and process complex healthcare, dialysis, and stop loss claims from intake through resolution
• Examine claims against company policy and regulatory requirements
• Complete claims work within required timeframes while maintaining accuracy
• Serve as a go-to resource for complex questions and escalations
• Review plan documents and vendor arrangements to validate system configuration
• Identify and escalate potential errors in plan documents, claims processing, or system setup
• Manage assigned stop loss renewal tasks accurately and on schedule
• Complete required training and stay current on regulatory and industry standards
• Support clients, internal staff, and vendors with claims questions
• Resolve claims questions and keep cases moving
• Take on special assignments that strengthen the broader claims operation

Senior High Risk Claims Specialist

Data Analyst

• Maintain an understanding of workflows between operational departments
• Communicate ongoing task status regularly to end users and the Team Lead or DataOps Manager
• Analyze insurance claims, import/export files, and eligibility file mappings to troubleshoot operational inquiries
• Identify technical issues from improper enrollment or enrollment changes on EDI files
• Coordinate with engineering partners to resolve EDI issues
• Coordinate ongoing EDI testing, implementations, and upgrades
• Troubleshoot and report operational error messages
• Troubleshoot and report file movement errors, including SFTP connection errors
• Compare reports and data files against documented business requirements to ensure quality and identify gaps
• Perform other duties assigned by the Team Lead or DataOps Manager

Data Analyst, Data Operations

• Maintain and troubleshoot ETL/ELT data pipelines for healthcare and TPA claims processing
• Use Python and SQL for data extraction, transformation, validation, and loading across on-premises and cloud environments
• Monitor pipeline performance, review logs, investigate failed jobs, and correct data discrepancies
• Handle support tickets approximately 50% of the time, responding to user requests and resolving operational data problems
• Monitor daily production processes, jobs, application performance, and application maintenance
• Support data management in PostgreSQL, Oracle, AWS RDS, and cloud-based databases
• Learn and support data workflows, healthcare data formats, file transfers, and reporting processes with senior team members
• Maintain data quality and accuracy through routine checks, documentation, and follow-up
• Collaborate with Data Analysts, Developers, and business users on data needs, reporting, and data operations
• Participate in team meetings, sprint activities, and knowledge-sharing

Data Operations Engineer

Account Specialist

• Collaborate across business functions to meet client needs and follow through on outstanding items until resolution
• Track internal performance to confirm client expectations are consistently met
• Maintain accurate, up-to-date client records
• Research complex issues, access necessary resources, and escalate to appropriate internal experts
• Participate in and host client meetings as needed
• Assist in organizing open enrollment strategies, health fairs, and employee education sessions
• Support Account Managers during the contract renewal process
• Provide ongoing analysis and strategic input for client success

Customer Support

• Review and answer service requests from internal and external customers accurately and on time
• Enter and manage case data, keeping records complete and audit-ready
• Build monthly reports, maintain logs, and produce flyers and data summaries
• Create, manage, and pull invoices to confirm payment, revenue, and expenses
• Organize project folders and files
• Plan and carry out assignments to meet productivity, quality, and turnaround requirements
• Maintain documentation and processes for URAC and NCQA external audits
• Escalate department or employee concerns appropriately
• Participate in routine meetings and keep shared task lists and project trackers current
• Maintain HIPAA compliance, uphold confidentiality standards, and complete required annual training

Care Management Support Specialist I

Data Scientist

• Manage teams responsible for ingesting, processing, and/or delivering files across the enterprise
• Set clear standards and measurements for team performance
• Coordinate with Team Leads and Individual Contributors to understand performance trends and solve business challenges
• Collaborate with cross-functional teams on business requirements for client implementations, issue resolution, renewals, and change requests
• Collaborate on requirements for new or enhanced product features
• Provide direction and support for leadership development
• Own sections of the data pipeline, including handoffs, monitoring, quality controls, and workflow management
• Oversee comprehensive documentation of data analysis and data engineering processes, architecture, and workflows
• Design, build, and maintain data pipelines, data models, and data solutions
• Analyze mappings of insurance claims, import/export files, and eligibility files for troubleshooting
• Identify technical issues from improper enrollment or enrollment changes on EDI files and coordinate resolution with engineering partners
• Coordinate client implementation and EDI testing, implementations, and upgrades
• Translate business requirements into actionable solutions aligned with organizational goals
• Create ad hoc SQL queries to support Operations
• Build and maintain file transmissions through file transfer tools such as GoAnywhere and MoveIt

Manager, Data Operations Integrations

Events

• Manage the planning, coordination, execution, and measurement of national events and conferences supporting Personify Health’s Wellbeing growth strategy
• Coordinate event logistics, vendors, materials, timelines, registration, reporting workflows, stakeholder updates, shipping, inventory, and on-site support
• Support the national Wellbeing event and conference calendar
• Partner with Demand Generation, Marketing Operations, Sales, Product Marketing, Account Management, Consultant Broker Relations, Creative, Procurement, Finance, and other stakeholders
• Assist with sponsorship, speaking opportunity, booth, promotional, and attendee engagement planning
• Coordinate assigned national events and conferences, plus regional events, partner events, and virtual experiences as needed
• Manage A/V needs, booth materials, speaker details, registration requirements, attendee communications, and on-site support
• Create and maintain event project plans, checklists, run-of-show documents, attendee lists, stakeholder updates, landing page inputs, and post-event recaps
• Travel as needed to support on-site execution, setup, and attendee experience, escalating issues when necessary
• Track event budgets, purchase requests, vendor approvals, invoice status, and final costs
• Maintain event records covering attendance, meeting requests, lead capture, campaign association, follow-up status, and post-event notes
• Support lead routing, Salesforce campaign setup, landing page requests, attribution tracking, and post-event follow-through
• Compile post-event feedback and performance inputs

Events Specialist

Product Marketing

• Define how Personify Health’s Wellbeing solutions appear in the market and connect to buyer needs
• Translate product capabilities, market insights, and customer needs into positioning, messaging, GTM plans, and commercial content
• Build expertise in the Wellbeing market, priority segments, buyer personas, customer needs, industry trends, sales motions, and competitive dynamics
• Synthesize win/loss insights, sales conversations, customer feedback, analyst inputs, and competitive intelligence
• Develop differentiated positioning, messaging, value propositions, proof points, and buyer narratives
• Plan and execute GTM motions for new solutions, releases, enhancements, packaging updates, and commercial initiatives
• Partner with Product on roadmap discussions, launch planning, commercial narratives, and enablement plans
• Design and activate GTM readiness for Sales, SAE, Account Management, CBR, and other customer-facing teams
• Create and maintain enablement materials, talk tracks, objection handling, competitive guidance, discovery questions, presentations, demos, FAQs, proposal language, and training content
• Create and maintain solution narratives, sales decks, one-pagers, case study inputs, demo scripts, website and campaign inputs, event messaging, proposal content, customer communications, and executive-ready materials
• Align Product, Marketing, Enablement, Sales, SAE, Account Management, Operations, Legal, Finance, and other stakeholders
• Facilitate working sessions, capture decisions, manage dependencies, and drive clarity across initiatives
• Define, track, and report product marketing performance indicators
• Use results to refine messaging, improve enablement, prioritize updates, and strengthen GTM motions
• Embody Personify Health’s core values and perform other duties as assigned

Product Marketing Manager

Health Coordinator

• Support the full implementation lifecycle for new group implementations from kickoff through go-live
• Create and own detailed project plans for each new piece of business
• Coordinate with internal departments to set accurate and realistic deadlines
• Track deliverables across cross-functional teams and follow up on missed milestones
• Escalate timeline risks to leadership
• Lead internal implementation meetings to surface blockers and align stakeholders
• Identify and manage implementation risks and develop action plans
• Audit new client account configurations across internal systems before go-live

Implementation Coordinator – Health Plans, TPA

Business Intelligence Analyst

• Maintain strong working knowledge of Personify Health products and reporting capabilities
• Work with Implementation, Account Management, and Operations to understand client and service delivery reporting needs
• Triage reporting requests and determine whether they can be supported and automated in Genesys, Calabrio, or Empower
• Route unsupported standard reporting requests in Excel to the Microstrategy team
• Build standard reports in Excel, Genesys, Calabrio, and Empower
• Set up automated jobs to deliver reports to clients on agreed-upon cadences
• Update existing reports based on client change requests and contractual obligations
• Analyze data discrepancies to determine error sources and resolutions
• Innovate processes to improve standard reporting performance
• Maintain and deliver timely reports from the ticketing system
• Perform additional duties as requested

Reporting Analyst

Trainer

• Design and deliver instructor-led, virtual, and self-paced examiner training
• Cover adjudication logic, benefit interpretation, coordination of benefits, and system navigation
• Manage session scheduling, progress tracking, and certification
• Partner with Quality Audit to convert error trends into targeted refresher training
• Train team leads and subject-matter experts to deliver training
• Track quality, productivity, and turnaround time against training outcomes
• Build and launch training for new lines of business, system rollouts, and platform migrations
• Author and maintain claims procedures, workflow guides, and job aids
• Translate regulatory, policy, and configuration updates into same-day guidance
• Maintain a version-controlled procedure library
• Validate procedures against state, federal, ERISA, and CMS requirements
• Build process flow diagrams and decision trees for complex claims
• Validate training and procedure content against live system benefit configuration
• Coordinate go-live readiness with IT and platform vendors
• Provide organized documentation for regulatory exams and internal reviews
• Surface process, training, and documentation gaps to Claims Operations leadership

Claims Trainer

• Contact patients directly and complete thorough assessments covering physical, psychosocial, emotional, spiritual, environmental, and financial needs
• Use claims processing tools to review paid claim data and identify members needing case management or specific programs
• Develop treatment plans for standard and catastrophic cases with patients, caregivers, community resources, and multidisciplinary providers
• Set clear short- and long-term goals
• Monitor interventions and evaluate treatment plan effectiveness
• Report measurable outcomes
• Maintain ongoing contact with patients, families, providers, employers, and the broader care team throughout the continuum of care
• Facilitate access to quality care and provide emotional support and guidance
• Negotiate and implement cost management approaches
• Reflect cost management impact in monthly case management reviews and cost avoidance reports
• Conduct utilization review for assigned members
• Evaluate patient needs and make referrals to wellness programs
• Maintain complete, confidential documentation in Eldorado and UM Web
• Prepare reports at 30-day intervals for high-risk cases and 90-day intervals for low-risk cases according to Company policy and HIPAA
• Serve as a clinical resource for LVNs and guide complex cases and clinical decision-making

Case Manager, Nurse, RN

Program Manager

• Define, design, develop, communicate, and execute a comprehensive health and wellbeing strategy
• Develop and execute health and wellbeing programs according to timelines and budgets
• Monitor, evaluate, and respond to program measurements and participant feedback
• Drive continuous quality improvement initiatives and goals
• Serve as an integrated partner and the face of wellbeing to the client population
• Guide members to appropriate resources and programs
• Serve as a Personify Health platform expert and customize the platform experience locally
• Deliver custom engagement initiatives and product demonstrations to drive enrollment and engagement
• Partner with client leadership, stakeholders, and internal groups to build and support a culture of health
• Leverage community partnerships to support social determinants of health, diversity and inclusion, and holistic wellbeing initiatives
• Collaborate with Personify Health, the client’s health plan, and vendor partners to identify health awareness and engagement opportunities
• Drive utilization of the client’s health, benefits, and wellbeing programs
• Launch and lead a Wellness Champion Network
• Lead implementation of health promotion programs, including health screenings, flu shots, and open enrollment events
• Lead regular data assessment and reporting to internal and external stakeholders and leadership
• Define opportunities, track impact, and determine next best steps
• Adapt wellbeing programs to meet diverse needs and cultural nuances
• Perform other related duties as assigned