Claims Administrator I

Who We Are

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

At Machinify, we’re constantly reimagining what’s possible in our industry—creating disruptively simple, powerfully clear ways to maximize our clients’ financial outcomes today and drive down healthcare costs tomorrow. As part of the Complex Payment Solutions Team, you will, as a Claims Administrator I, be responsible for supporting efficient claims processing and ensuring data accuracy throughout the review and auditing process. This role involves performing incoming claim reviews, organizing data, assigning statuses, and routing completed files to auditors while maintaining document hygiene and adhering to internal procedures.

The position requires close collaboration with internal teams to manage import queues, reconcile balances, validate charges, identify, and address errors, and facilitate claims routing. The Claims Administrator I oversee the intake and output of files, responding to inquiries, resolving discrepancies, and ensuring effective communication regarding claims.

Additionally, this role includes analyzing data trends, monitoring file-sharing processes, verifying data transfer accuracy, and ensuring appropriate volume levels are maintained. Data entry of documents and other administrative tasks are also integral to the position.

The ideal candidate demonstrates strong organizational skills, attention to detail, and the ability to work collaboratively in a dynamic environment.

What You’ll Do

• Review incoming claims, assign statuses, organize data, and route files to auditors.
• Collaborate with teams to manage the import queue, reconcile balances, validate charges, correct errors, and route files.
• Oversee file intake and output, addressing inquiries, discrepancies, and errors.
• Analyze data trends and communicate updates on claims routing, efficiency, inventory, and volume.
• Monitor file-sharing processes, ensure data transfer accuracy, and maintain appropriate volume levels.
• Perform data entry and support additional administrative tasks as needed.

What Experience You Bring (Role Requirements)

• Preferred experience in medical record review and knowledge of medical terminology.
• Proficient in Microsoft Office Suite, Adobe Acrobat, and multi-monitor setups; adaptable to company-specific software.
• Strong attention to detail, organizational, analytical, and critical thinking skills.
• Excellent interpersonal and teamwork abilities, capable of collaborating across functions and driving change.

What Success Looks Like…

After 3 months

• You will have a strong understanding of the role.
• You begin building relationships and collaborating with peers.
• You develop effective time and priorities management.
• You receive initial feedback about your performance and are using it to improve.
• You’ve gained confidence in your abilities and are starting to feel more comfortable in your role.

After 1 year

• You have mastered the tasks and responsibilities of the position, executing them with confidence and efficiency.
• You have established a strong network of internal relationships and are recognized as a key collaborator.
• You’ve been entrusted with greater responsibility indicating the company’s confidence in your abilities.
• You see opportunities for career progression and personal development.

What’s In It For You

• PTO, Paid Holidays, and Volunteer Days
• Eligibility for health, vision and dental coverage, 401(k) plan participation with company match, and flexible spending accounts
• Tuition Reimbursement
• Eligibility for company-paid benefits including life insurance, short-term disability, and parental leave.
• Remote and hybrid work options

Key skills/competency

• Claims Processing
• Data Accuracy
• Medical Terminology
• Microsoft Office Suite
• Adobe Acrobat
• Organizational Skills
• Attention to Detail
• Analytical Skills
• Critical Thinking
• Teamwork