Healthcare Claims Manager

Manager Of Healthcare Claims Ingestion & Data Integration

Ready to create a healthier world? 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.

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 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.

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 :

The strategic competencies :

The professional qualities :

We believe in total rewards that actually matternot just competitive packages, but benefits that support how you want to live and work.

Your wellbeing comes first :

Financial security that makes sense :

Growth without limits :

A culture that energizes :

The practical stuff :

Ready to create a healthier world? We're ready for you.

No candidate will meet every single qualification listed. If your experience looks different but you think you can bring value to this role, we'd love to learn more about you.

Personify Health is an equal opportunity organization and is committed to diversity, inclusion, equity, and social justice.

In compliance with all states and cities that require transparency of pay, the base compensation for this position ranges from $116,000 to $130,000. Note that compensation may vary based on location, skills, and experience. This position is eligible for 10% target bonus / variable compensation as well as health, dental, vision, mental health and other benefits.

We strive to cultivate a work environment where differences are celebrated, and employees of all backgrounds are empowered to thrive. Personify Health is committed to driving Diversity, Equity, Inclusion and Belonging (DEIB) for all stakeholders : employees (at each organization level), members, clients and the communities in which we operate. Diversity is core to who we are and critical to our work in health and wellbeing.