Payor Intelligence Sr. Analyst

Role overview

A healthcare technology company is building out a zero-to-one payor intelligence function to support its patient-access platform.

The Senior Analyst will own the end-to-end mapping of how U.

S. payors relate to one another, turning fragmented industry data into durable, product-ready logic.

This is a high-ownership role for someone with deep institutional expertise who can drive decisions independently and partner across engineering, clinical, and operations.

Responsibilities

• Build and maintain payor entity mapping, including hierarchies, families, subsidiaries, TPAs, PBMs, and delegated relationships that govern coverage and authorization.
• Source, interpret, and version medical policies, coverage criteria, government guidance, and fee schedules with clear provenance and effective dating.
• Design the delegated-relationship logic that determines which entity owns a prior authorization decision for any given plan, product, or service.
• Track clinical content dependencies such as Inter Qual and NCCN, identifying contract needs and renewal timing.
• Reconcile prospect and customer payor data against the internal payor model, converting recurring manual work into a repeatable system.
• Operate with a founder mindset, driving ambiguous projects from concept to completion with minimal handholding.

Requirements

• 5+ years working broadly across the U. S. payor landscape, including Medicare, Medicare Advantage, Medicaid and MCOs, and commercial lines of business.
• Deep fluency in payor structure: parent organizations, subsidiaries, regional versus national plans, self-funded versus fully insured arrangements, and delegated entities.
• Demonstrated ability to research and reconcile payor policies, fee schedules, and clinical guidelines, including resolving conflicting sources.
• A track record of building taxonomies, frameworks, databases, or mapping systems that other teams rely on.
• Strong analytical and pattern-recognition skills with the instinct to work productively from incomplete information.
• Excellent communication skills, able to explain complex payor concepts to technical and non-technical audiences alike.
• Nice to have
• Familiarity with SQL or comparable data tooling.

Benefits and work setup

• Remote flexibility with quarterly in-person collaboration at a Hudson Square office.
• Unlimited paid time off.
• 100% employer-paid employee health benefit options.
• Employer-funded 401(k) match.
• Competitive parental leave.
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