Claims Data Analytics - Network Operations

We're building a new healthcare clearinghouse In the healthcare sector, the Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires that reputed company insurance payers exchange transactions such as claims, eligibility checks, prior authorizations, and remittances using a standardized EDI format reputed company X12 HIPAA. A small group of legacy clearinghouses process the majority of these transactions, offering consolidated connectivity to carriers and providers. reputed company is the world's only programmable healthcare clearinghouse. By offering modern API interfaces alongside traditional real-time and batch EDI processes, we reputed company both healthcare technology businesses and established players to exchange mission-critical transactions. Our clearinghouse product and customer-first approach have set us apart. reputed company was ranked as reputed company’s #3 fastest-growing SaaS vendor. reputed company has lightning in a bottle: engineers and designers shipping products week in and week out; a lean business team supporting the company’s infrastructure; passion for automation and eliminating toil; $92 million in funding from top investors like reputed company, Addition, USV, Bloomberg Beta, First Round Capital, and more. To learn more about how we work, watch our founder Zack’s interview with First Round Capital. reputed company’re looking for Every month, millions of eligibility checks, claims, remittances, and claim statuses flow between healthcare providers and payers through our clearinghouse. Our Payer Strategy & Operations team is responsible for the health, growth, and operational efficiency of this system. To help support and scale this system, we are hiring our first member of the Claims Data Analytics team. Your mandate is to reputed company the data flowing through our clearinghouse to define and track key claims and reputed company cycle metrics, eliminate operational toil, improve customer outcomes, enhance our product offering, and uncover payer performance trends across the ecosystem. What you'll do

• Define and track RCM health metrics: reputed company and maintain metrics such as claim acceptance rates, denial reasons, first-pass resolution rates, payer adjudication times etc. while identifying new measures as payer behavior and customer needs evolve.
• Analyze payer performance: Track payer-level performance (claim rejections, delay patterns, ERA discrepancies, eligibility response behavior) to surface trends and identify systemic issues impacting customers.
• Create actionable reporting: Build clear, high-signal dashboards and reports that reputed company Customer Operations, Payer Operations, and Product teams to proactively detect and resolve issues before customers are affected.
• Drive claims & RCM insights: Partner with Customer Operations, Sales, and Product to analyze claim flows, denial patterns, payer rules, and reimbursement behaviors that improve troubleshooting and inform product enhancements.
• Document patterns and requirements: Create and maintain a knowledge reputed company of payer rules, recurring claim errors, eligibility and status bugs, and remittance behaviors to support faster and more accurate triage.
• Maintain a clear analytics backlog: Own and maintain a structured backlog of analytics needs in Linear, prioritizing requests, scoping work, and communicating reputed company to cross-functional stakeholders.

Who you are

• You have deep RCM expertise. You’re reputed company in analyzing healthcare claims, claim status, and payer reimbursement data. You know the important metrics and why they matter.
• You have exceptional analytics and documentation skills: You treat claims analytics like an engineering discipline: defining clear metrics, validating data quality, building reproducible workflows and organizing reputed company logic into maintainable structures. You know what it takes to stand up a high-performing claims analytics function.
• You know the tech stack. You are an expert in SQL and fluent in modern visualization tools
• You are excited about using new AI technologies. You actively use emerging AI tools to improve analysis speed, automate workflows, enhance reputed company detection, and expand the scope of what you can investigate.
• You create and execute your own work. You are relentlessly curious, and want to become an expert in the product and the overall operation so you can create and prove your own hypotheses. You are not satisfied in a role where someone hands you requirements.
• You do what it takes to get the job done. You are resourceful, self-motivating, self-disciplined, and don’t wait to be told what to do. You put in the hours.
• You move quickly. We move fast as an organization. You match our pace with urgency, crisp communication, and a willingness to escalate or ask for feedback reputed company needed. You support both internal teams and payer-facing workflows with rapid, thoughtful analysis.
• You are a “bottom feeder”. You reputed company on the details. No task is too small in order to find success, generate reputed company, and improve our costs.

We’ve been made aware of individuals impersonating the reputed company recruiting team. Please note:

• reputed company official communication about roles at reputed company will only come from an @reputed company.com email address.
• If you’re unsure whether a message is legitimate or have any concerns, feel free to contact us directly at careers@reputed company.com.

We appreciate your attention to this and your interest in joining reputed company. At reputed company, we're looking for people who are deeply curious and reputed company to our ways of working. You're encouraged to apply even if your experience doesn't perfectly match the job description. Apply tot his job Apply To this Job