Claims Data Strategy Lead (Healthcare)

TL;DR

Claims Data Strategy Lead (Healthcare): Providing senior-level, hands-on leadership across complex healthcare claims data initiatives with an accent on data modeling, adjustment sequencing, and performance optimization. Focus on independently driving end-to-end solutions, translating disparate claims data into scalable analytics, and ensuring data integrity across medical, pharmacy, and behavioral health domains.

Location: Remote

Company

hirify.global is an industry-insider firm dedicated to reducing healthcare costs for self-funded employers through proprietary data analysis.

What you will do

• Own and drive end-to-end solutions for healthcare claims data initiatives from definition to validation.
• Design and optimize advanced SQL-based data models and automation frameworks for scalability.
• Develop complex claim adjustment sequencing and disposition logic for disparate source configurations.
• Build utilization metrics across inpatient, outpatient, professional, and behavioral health service levels.
• Independently assess unfamiliar data environments and resolve data gaps or risks proactively.
• Partner with product, engineering, and leadership teams to align data assets with business objectives.

Requirements

• 7-10 years of experience in healthcare data with deep specialization in claims analytics.
• Expert-level proficiency in SQL and advanced query development for large, complex datasets.
• Strong understanding of healthcare claims structures including medical, pharmacy, and behavioral health.
• Proven ability to independently assess data environments and develop working solutions.
• Excellent communication skills for collaborating with technical and non-technical stakeholders.
• Ability to operate with high autonomy and take full ownership of complex initiatives.

Nice to have

• Experience with FACETs, BlueChip, Prime Therapeutics, ESI, or aggregated claims sources.
• Hands-on knowledge of healthcare standards such as 837, 834, 820, HL7, and CCDA.
• Background in building reusable, table-driven logic and automation frameworks.
• Experience supporting analytics or product use cases in payment integrity contexts.

Culture & Benefits

• High degree of autonomy and ownership in a senior individual contributor role.
• Opportunity to make a meaningful impact on healthcare cost reduction.
• Collaborative environment working closely with product and engineering leadership.