Pharmacy Validation Specialist

Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plan clients across the country. Deployed by over 85 health plans, including many of the top 20, and representing more than 270 million lives, Machinify brings together a fully configurable and content-rich, AI-powered platform along with best-in-class expertise. We’re constantly reimagining what’s possible in our industry, creating disruptively simple, powerfully clear ways to maximize financial outcomes and drive down healthcare costs.

About the Opportunity

A Payment Integrity Validation Specialist is an integral part of a dynamic team, aiding in the facilitation of coordination of benefits. Validation Specialists utilize access to insurance eligibility and claims payment information as well as outreach to insurance carriers to ensure member records are accurate. This role builds a foundation of knowledge that supports future advancement.

What you’ll do

• Verifies medical insurance eligibility data.
• Accurately documents data gathered.
• Meets daily production quotas
• Follows specific timeframes to complete tasks.
• Uses multiple computer systems to work efficiently.
• Provides excellent customer service.

What experience you bring (Role Requirements)

• High School diploma, GED, or equivalent combination of experience.
• Experience with health insurance ispreferred, but not required.
• Excellent oral and written communication skills, including on the phone, are required.
• Ability to work well independently or in a team environment.
• Very strong attention to detail and organizational skills.
• Word and Excel proficiency required.
• Experience in the healthcare field is helpful, but not required.

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.

Pay range: $22.00/hour. This is a non-exempt position.

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