Payor Intelligence Senior Analyst

Owns the company’s payor intelligence function by mapping complex payer entities and delegated relationships, governing policy data, and translating coverage realities into product requirements. Requires 5+ years across U.S. Medicare, Medicaid, commercial payors, and related healthcare arrangements.

About the job

Responsibilities

Build and own payor entity mapping, including hierarchies, families, subsidiaries, TPAs, PBMs, and delegated relationships.
Source, interpret, and govern medical policies, coverage criteria, government guidance, and fee schedules with effective dating, provenance, and version control.
Design delegated-relationship logic for prior authorization and determine which entity owns decisions for plans, products, and services.
Identify and track clinical content sources such as InterQual and NCCN, including contracting needs and timing.
Map prospect and customer payor data to the company’s payor model and turn manual work into a repeatable system.
Drive projects from conception through completion with high ownership.

Requirements

5+ years working across the U.S. payor landscape.
Broad experience with Medicare, Medicare Advantage, Medicaid and Medicaid MCOs, and commercial lines of business.
Fluency in payor families, subsidiaries, TPAs, PBMs, delegated entities, regional and national plans, and self-funded versus fully insured arrangements.
Experience researching and interpreting payor policies, government guidance, fee schedules, or clinical guidelines.
Ability to reconcile conflicting information from multiple sources.
Track record of building taxonomies, frameworks, databases, or mapping systems used by others.
Strong analytical, pattern-recognition, investigative, communication, and self-directed ownership skills.

Nice to Have

Familiarity with SQL or comparable data tooling.

Compensation and Benefits

Salary: $90,000–$110,000 annually.
Remote flexibility.
Unlimited PTO.
100% paid employee health benefit options.
Employer-funded 401(k) match.
Competitive parental leave.
Quarterly travel to the Hudson Square office.

Skills

Payor Intelligence, Medicare, Medicare Advantage, Medicaid, Medicaid Mcos, Commercial Insurance, SQL, Taxonomies, Data Mapping, Prior Authorization, Medical Policies, Fee Schedules, Clinical Guidelines, Pbms, Tpas