HCS Operations Inventory & Quality Analyst (Eligibility)

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:

Hiring Range: $61,300 - $73,000

The HCS Operations Inventory & Quality Analyst (Eligibility), leverages strong knowledge of healthcare eligibility, healthcare claims, eligibility validation practices, Coordination of Benefits and Third-Party Liability (COB/TPL), or Medicare Secondary Payer (MSP), plus strong data analysis and technical skills to support inventory management, process documentation, and production QA process for assigned operations teams in the Eligibility organization.

Key Responsibilities

• Work closely with the operations teams and data team to ensure inventory is accurately and efficiently distributed/assigned and transferred across teams based upon applicable inventory type workflow and requirements.

• Conduct auditing of operations team activities on inventory to validate compliance with internal requirements, client contracts, regulatory requirements, and industry quality standards.

• Facilitate communications and collaborate to convey/clarify requirements for inventory data flow based upon client/type/source serving as a liaison between the operations and eligibility & analytics data team.

• Utilize SQL queries (and develop queries as may be needed) and leverage subject matter knowledge, independent judgement, and analytical skills to:

• Test data transfer/flow results.

• Perform audit activity.

• Create and maintain regular internal/external activity and metrics reporting; and

• Other support for operations workflow and activity.

• Mentors operations team and data team on paper and electronic claims processes

• Creates and maintains internal and external reporting as needed.

• Contribute to development and continuous improvement of operational tools, processes and procedures for quality and inventory.

• Provides Supervisors/Management with staff production quality results, as well as any insights for feedback/coaching/training opportunities based upon themes/trends identified to correct areas of quality deficiency and improve overall results.

• May support management with developing or delivering training and tools for skills development to increase capability and effectiveness of analysts.

• Operates under minimal supervision to deliver results aligned with business goals, given guidance in the form of high-level objectives.

• 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.

• Correct areas of deficiency and/or areas of opportunity for improvement received from management.

Knowledge, Skills and Abilities Needed

• Knowledge and experience with rules around Medicaid / Medicare COB Other TPL business models and products

• Skilled working with operations systems, tools, and applications for collecting and reporting data as well as identifying trends.

• Demonstrated ability to work with large volumes of healthcare eligibility and claims data.

• Intermediate skills in MS Excel required.

• Utilization of SQL to run queries. Ability to develop basic queries a plus.

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

• General knowledge of 270/271, 834, 277, 837, 835 highly desired

• Familiarity with JIRA a plus

• Professional verbal and written communication with good presentation skills

• Ability to follow, document, and teach, as well as support improvement of, processes, procedures, and workflow.

• Ability to work independently with minimal supervision

• Strong analytical and problem-solving skills

• Skilled at gathering, researching, interpreting, and documenting data and requirements for projects and/or complex problem solving.

• Ability to produce results and maintain positive attitude in a dynamic environment.

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

• Protects patients’ privacy, understands, and adheres to HIPAA standards and regulations.

• Self-motivated and thrives in a fast-paced office environment performing multiple tasks cohesively, with keen attention to detail.

• Ability to adapt quickly and transition effectively to changing circumstances, client requirements, assignments, and business needs.

• Ability to consistently perform job responsibilities.

Required and Preferred Qualifications

• Bachelor’s degree in relevant field, or equivalent combination of education and experience.

• At least three (3) years of directly related progressive experience (claims, billing, eligibility, Medicaid/Medicare, etc.), including Coordination of Benefits and Third-Party Liability, demonstrating depth and breadth of knowledge and capability required for the position.

• Minimum two (2) years relevant experience demonstrating ability to work with large volumes of healthcare eligibility or client data, including data reporting, modeling, and analysis.

• Minimum 1 year of relevant experience in role(s) with responsibility for applying subject matter expertise to operations workflow, contributing to the set-up of new clients or programs, projects, quality/auditing, direct or indirect staff oversight or training, etc. and contributing to the development of infrastructure and continuous improvement for department output.

• Other requirements and qualification may apply.

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