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Payor Data Solutions Lead

firsthand

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Location:
United States

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Category:
IT - Software Development

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Contract Type:
Not provided

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Salary:

150000.00 - 160000.00 USD / Year

Job Description:

firsthand supports individuals living with SMI (serious mental illness). Our holistic approach includes a team of peer recovery specialists, benefits specialists and clinicians. Our teams focus on meeting each individual where they are and walking with them side by side as a trusted guide and partner on their journey to better health. firsthand's team members use their lived experience to build trust with these individuals and support them in reconnecting to the healthcare they need, while minimizing inappropriate healthcare utilization. Together with our health plan partners, we are changing the way our society supports those most impacted by SMI. We are cultivating a team of deeply passionate problem-solvers to tackle significant and complex healthcare challenges with us. This is more than a job—it's a calling. Every day, you will engage in work that resonates with purpose, gain wisdom from motivated colleagues, and thrive in an environment that celebrates continuous learning, creativity, and fun.

Job Responsibility:

  • Own the end‑to‑end lifecycle of partner data that powers customer success, value creation, and operational execution
  • Steward monthly batching and claims ingestion
  • Manage attribution end to end
  • Surface issues that impact value realization
  • Partner with Customer Success in MORs through clear storytelling, insight packaging, and problem solving with payer partners
  • Triage and deliver on pre‑/post‑sales data asks
  • Support file onboarding and steady‑state flows end to end
  • Set clear specs and SLAs, author mappings and test plans, and monitor pipelines into Snowflake so downstream dashboards and SLAs run without interruption
  • Support MORs
  • Run monthly batching and support Eng in claims ingestion
  • Manage payer data implementations
  • Monitor and resolve anomalies like unexplained churn or delayed BenSupp rate‑cell transitions, and manage automations for said checks
  • Define and QA attribution logic
  • Operate monthly batching and claims ingestion with tight controls, tracking adds/deletes and net attribution changes
  • Reconcile with payer data teams

Requirements:

  • 4+ years in Data Product Management, Implementation, or Technical Program Management
  • 4+ years working with healthcare payers or PBMs on data integration projects (claims, eligibility, enrollment, provider, or remit files)
  • Proven experience operating recurring ingestion pipelines and data quality controls in production
  • Strong communicator who can translate between technical and non‑technical stakeholders and craft payer-ready narratives
  • Strong organization and documentation habits with repeatable processes and playbooks
  • Strong working knowledge of SQL, data modeling, and common healthcare file formats (e.g., 837/835/834, custom delimited extracts)
  • Experience with Apache Airflow, DBT, and ETL / ELT tools, and cloud platforms (e.g., AWS, GPC)

Nice to have:

  • Experience with BI tools such as Looker, Tableau, Power BI, or QuickSight
  • Experience in value‑based care and payer reporting constructs (e.g., MLR, risk corridors)
  • Experience with eligibility verification/management vendors or mastering member identity across sources
What we offer:
  • Equity (or a special incentive program for clinical roles)
  • Performance bonus potential
  • Physical and mental health benefits
  • Dental
  • Vision
  • 401(k) with a match
  • 16 weeks parental leave for either parent
  • 15 days/year vacation in your first year (this increases to 20 days/year in your second year and beyond)
  • Supportive and inclusive culture

Additional Information:

Job Posted:
December 08, 2025

Employment Type:
Fulltime
Work Type:
Remote work
Job Link Share:
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