Eligibility and Recovery Claims Lead

ABOUT MACHINIFY:

In October 2025, Machinify acquired Performant and we are now part of the Machinify organization. Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plans. Deployed by over 75 health plans, including many of the top 20, and representing more than 170 million lives, Machinify's AI operating system, combined with proven expertise, untangles healthcare data to deliver industry-leading speed, quality, and accuracy. We're reshaping healthcare payment through seamless intelligence.

ABOUT THE OPPORTUNITY:

The Eligibility and Recovery Claims Lead will possess advanced knowledge of healthcare eligibility, healthcare claims, medical terminology, eligibility validation practices, Coordination of Benefits and Third-Party Liability (COB/TPL). This position will also support new client implementations and existing programs with detailed analysis of all claiming operations, including but not limited to outgoing and incoming healthcare EDI transactions.

Key Responsibilities to include:

• Leverage knowledge and expertise in COB and TPL review healthcare claims and client data.

• Review and analyze client data to identify trends, patterns and identify impact across various products.

• Assist technical and business leads with requirements gathering, documentation, and project management for new implementations and existing program changes.

• Conducts a variety of data analysis for intelligent insights using subject matter knowledge, independent judgement, and analytical expertise.

• Develops custom queries and reporting, conducts research, analyzes trends and activities, and presents data and findings based upon business needs and as need to identify opportunities, root causes of issues and to support business decisions and strategies.

• Collaborates with leadership to provide effective and detailed analysis required for optimal business operations.

• Maintains a strong team through meetings, training, coaching, mentoring and other development techniques.

• Follows and complies with company, departmental and client program policies, processes, and procedures.

• Responsible for utilizing resources to ensure compliance with client requirements, HIPAA, as well as applicable federal or state regulations.

• Successfully completes, retains, applies, and adheres to content in required training as assigned.

• Completes required processes to obtain client required clearances as well as company regular background and/or drug screening; and successfully passes and/or obtains and maintains. clearances statuses as a condition of employment. (Note: client/government clearance requirements are not determined or decisioned by Performant.)

• Demonstrates Performant core values in performance of job duties and all interactions.

• Correct areas of deficiency and oversight received from quality reviews and/or management.

• Other duties as assigned.

Knowledge, Skills and Abilities Needed:

• Knowledge of and ability to work with large volumes of health care claims data.

• Knowledge of healthcare medical and pharmacy claims

• Experience with Medicaid / Medicare / Other TPL business models and products

• Knowledge of requirements gathering, ETL processing and data matching

• Strong system skills with ability to quickly develop expertise in new systems and applications

• Advanced skills in Excel, Access and/or other data analysis applications

• Proficient SQL skills to query and test

• Advanced knowledge of X12 EDI Transactions, including, but not limited to 270/271, 277, 837, 835, 834

• Professional verbal and written communication with good presentation skills

• Able to work independently and meet deadlines with minimal supervision

• Strong problem solving and communication (written and oral) skills

• Ability to produce results and maintain positive attitude in fast paced, dynamic environment

• Self-motivated and thrives in a fast-paced business operations department performing multiple tasks cohesively, with keen attention to detail

Required and Preferred Qualifications:

• Bachelor's degree in relevant field, or equivalent combination of education and experience may be considered

• 7+ years relevant experience working with healthcare claims data.

• 3+ years management or supervisory experience

• Advanced knowledge and experience with healthcare claim operations, Coordination of Benefits, and Third Party Liability

WHAT WE OFFER:

Machinify offers a wide range of benefits to help support a healthy work/life balance. These benefits include medical, dental, vision, HSA/FSA options, life insurance coverage, 401(k) savings plans, family/parental leave, paid holidays, as well as paid time off annually. For more information about our benefits package, please refer to our benefits page on our website or discuss with your Talent Acquisition contact during an interview.

Physical Requirements & Additional Notices:

If working in a hybrid or fully remote setting, access to reliable, secure high-speed Internet at your home office location is required. Proof of such may be required prior to an offer being made. It is the Employee's responsibility to maintain this Internet access at their home office location.

The following is a general summary of the physical demands and requirements of an Office/Clerical/Professional or similar job, whether completed remotely at a home office or in a typical on-site professional office environment. This is not intended to be an exhaustive list of requirements, as physical demands of each individual job may vary.

• Regularly sits at a desk during scheduled shift, uses office phone or headset provided by the Company for phone calls, making outbound calls and answering inbound return calls using an office phone system; views a computer monitor, types on a keyboard and uses a computer mouse.

• Regularly reads and comprehends information in electronic (computer) or paper form (written/printed).

• Regularly sit/stand 8 or more hours per day.

• Occasionally lift/carry/push/pull up to 10lbs.

Machinify is a government contractor and subject to compliance with client contractual and regulatory requirements, including but not limited to, Drug Free Workplace, background requirements, and other clearances (as applicable). As such, the following requirements will or may apply to this position:

• Must submit to, and pass, a pre-hire criminal background check and drug test (applies to all positions). Ability to obtain and maintain client required clearances, as well as pass regular company background and/or drug screenings post-hire, may be required for some positions.

• Some positions may require the total absence of felony and/or misdemeanor convictions. Must not appear on any state/federal debarment or exclusion lists.

• Must complete the Machinify Teleworker Agreement upon hire and adhere to the Agreement and all related policies and procedures.

• Other requirements may apply.

All employees and contractors for Machinify may and/or will have access to Sensitive, Proprietary, Confidential and/or Public data. As such, all employees and contractors will have ownership and responsibility to report any violations to the Confidentiality and Integrity of Sensitive, Proprietary, Confidential and/or Public data at all times. Violations to Machinify's policy related to the Confidentiality or Integrity of data may be subject to disciplinary actions up to and including termination.

Machinify is committed to the full inclusion of all qualified individuals. In keeping with our commitment, Machinify will take the steps to assure that people with disabilities are provided reasonable accommodations. Accordingly, if you believe a reasonable accommodation is required to fully participate in the job application or interview process, to perform the essential functions of the position, and/or to receive all other benefits and privileges of employment, please contact Machinify's Human Resources team to discuss further.

Our diversity makes Machinify unique and strengthens us as an organization to help us better serve our clients. Machinify is committed to creating a diverse environment and is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, age, religion, gender, gender identity, sexual orientation, pregnancy, age, physical or mental disability, genetic characteristics, medical condition, marital status, citizenship status, military service status, political belief status, or any other consideration made unlawful by law.

THIRD PARTY RECRUITMENT AGENCY SUBMISSIONS ARE NOT ACCEPTED UNLESS EXPLICITY AGREED TO IN WRITING