Payor Intelligence Sr. Analyst

PAYOR INTELLIGENCE SR. ANALYST

COMPANY DESCRIPTION

Today, when you go to your doctor and get referred to a specialist, your doctor sends out a referral and tells you, "They'll be in touch soon." So you wait. And wait. Sometimes days, weeks, or even months. Why? Because too often providers are overwhelmed with the painstakingly tedious work required to get paid by insurance companies. Powered by proprietary models, the company handles the complex paperwork that gets patients through the door and providers paid, helping operators get patients the right care, at the right time, in the right setting.

ROLE DESCRIPTION

We're seeking a Payor Intelligence Analyst with deep knowledge of the U.S. payor landscape and a talent for turning fragmented, conflicting information into durable logic. Understanding how payors actually relate to one another, which entities own which plans, who delegates what, and which policy applies when, is work our entire product depends on. You'll build and own payor intelligence at the company as a zero-to-one function.

The payor landscape is a massive, constantly shifting dataset: parent organizations, subsidiaries, TPAs, PBMs, Medicaid MCOs, Medicare Advantage plans, delegated UM vendors, acquisitions, and rebrands. Your job is to make it legible, building the taxonomies, hierarchies, and governance that let our models and teams reason correctly about it, and translating that reality into product requirements alongside engineering, clinical, and operations.

If you've developed deep payer expertise inside a large organization, this is the rare seat with clear ownership and impact.

RESPONSIBILITIES

• Build and own payor entity mapping: the hierarchies, families, subsidiaries, TPAs, PBMs, and delegated relationships that define how coverage and authorization actually flow.

• Source, interpret, and govern medical policies, coverage criteria, government guidance, and fee schedules, establishing effective dating, provenance, and version control.

• Design the delegated-relationship logic behind prior authorization, determining which entity owns the decision for a given plan, product, and service.

• Identify and track the clinical content sources our policies depend on, such as InterQual and NCCN, and own what we need to contract for and when.

• Map prospect and customer payor data back to the company's payor model, turning a recurring manual effort into a repeatable system.

• Embrace a founder's mindset, proactively driving projects from conception to completion, and contributing significantly to our company's growth and success.

CANDIDATE QUALIFICATIONS

• 5+ years working across the U.S. payor landscape, with real breadth across Medicare, Medicare Advantage, Medicaid and MCOs, and commercial lines of business.

• Fluency in payor structure: payor families, subsidiaries, TPAs, PBMs, delegated entities, regional versus national plans, and self-funded versus fully insured arrangements.

• Experience researching and interpreting payor policies, government guidance, fee schedules, or clinical guidelines, including reconciling sources that disagree with each other.

• A track record of building taxonomies, frameworks, databases, or mapping systems that other people rely on, not just answering questions as they come in.

• Exceptional analytical and pattern-recognition skills, with the investigative instinct to work productively from ambiguous and incomplete information.

• Self-directed ownership of a domain end to end, without predefined process or constant validation.

• Outstanding communication skills, capable of articulating complex payor concepts to a diverse audience.

• Familiarity with SQL or comparable data tooling is a plus.

WHY the company?

• Drive Impact: one of our company values is Cowboy, meaning you set the pace. You won't just talk about things, you'll get them done. And feel the impact.

• Develop Operational Expertise: learn the inner workings of scaling systems, tools, and infrastructure

• Innovate with Purpose: we're not just doing this for fun (although we do have a lot of fun). At the company, you'll join a high-caliber team maniacally focused on reducing patient delays across the U.S. healthcare system.

• Build Relationships: collaborate and connect with like-minded, driven individuals in our Hudson Square office (travel to office on quarterly basis)

BENEFITS

• Remote Flexibility

• Unlimited PTO

• 100% paid employee health benefit options

• Employer funded 401(k) match

• Competitive parental leave