[Remote] Director | New Product R&D at Machinify

Palo Alto, California, United States

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Not SpecifiedCompensation

Senior (5 to 8 years), Expert & Leadership (9+ years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, HealthtechIndustries

Requirements

Strong, hands-on understanding of a Payment Integrity platform (e.g., Cotiviti, Machinify)
Direct experience working with Data Science
Deep expertise in Machinify’s platform capabilities (data ingestion/normalization, rules/decisioning, model training/evaluation, reviewer workbench, explainability/audit, X12/EDI integrations)
Expertise in Healthcare Payment Integrity across prepay and postpay use cases, including clinical, coding, and policy rigor
Knowledge of NCCI edits (PTP/MUE), DRG/APC logic, CMS NCD/LCD, plan-specific rules, and fraud/waste/abuse patterns

Responsibilities

Lead domain strategy within Product: Define the domain vision and standards for Payment Integrity, aligning with product strategy and business goals; establish governance for policy/clinical accuracy, model and rule validation, and compliance-by-design; set quality bar and go/no-go criteria for releases
Platform-first discovery and solutioning: Develop deep expertise in Machinify’s platform capabilities; use them to drive concept ideation and solution design, recommending configure-vs-build paths
Partner hands-on with Data Science: Define ground-truth labeling guidance, sampling strategies, and evaluation metrics (precision/recall, dollar yield, false positive rate, overturn rate, provider abrasion); review and critique features and model outputs; identify failure patterns and recommend adjustments; maintain curated test sets and UAT plans
Be the market and regulatory intelligence engine: Monitor and synthesize CMS updates (IPPS/OPPS), NCD/LCD, NCCI, state regulations, payer policy trends, provider billing behaviors, and competitive landscape; deliver concise POVs and impact briefs; translate shifts into product opportunities, risks, and design constraints
Bridge SME Operations insights into product decisions: Aggregate and structure inputs from SME Operations, client services, and customers into prioritized problem statements and actionable requirements
Support cross-functional execution and enablement: Participate in requirement reviews, design critiques, and readiness checks; oversee UAT; conduct trainings and workshops; create clear domain documentation
Measure outcomes and iterate: Define domain-level OKRs and success metrics with PM and DS (e.g., yield, accuracy, time-to-detect, overturns, provider abrasion); drive continuous improvement through analytics and qualitative feedback
Provide executive-level communication, influence, and stakeholder management across Product leadership

Skills

Key technologies and capabilities for this role

Payment IntegrityHealthcare PolicyProduct ManagementData ScienceMachine LearningRules EngineEDIX12Clinical CodingRegulatory ComplianceModel EvaluationProduct Strategy

Questions & Answers

Common questions about this position

Is this position remote?

Yes, the position is fully remote.

What is the salary or compensation for this role?

This information is not specified in the job description.

What key skills and experience are required for this role?

A strong, hands-on understanding of a Payment Integrity platform (e.g., Cotiviti, Machinify) and direct experience working with Data Science are required. Expertise in healthcare payment integrity across prepay and postpay use cases, including clinical, coding, and policy knowledge, is essential.

What does the company culture or work environment look like at Machinify?

This information is not specified in the job description.

What makes a strong candidate for this Director role?

Candidates with hands-on experience in Payment Integrity platforms, direct collaboration with Data Science teams, and deep knowledge of healthcare regulations like CMS updates, NCCI edits, and payer policies stand out. Ability to translate domain expertise into product requirements and partner across Product, Data Science, and Engineering is key.

Machinify

AI-driven solutions for healthcare administration

About Machinify

Machinify provides AI-driven solutions to improve decision-making in the healthcare industry. Its platform helps health plans, payers, and providers optimize their operations, particularly in areas like claims processing and utilization management. The applications offered by Machinify can be quickly deployed, allowing clients to see immediate returns on investment. This focus on rapid implementation sets Machinify apart from competitors, as healthcare organizations increasingly seek cost efficiency and better patient outcomes. The company's goal is to enhance operational efficiency and help clients manage healthcare expenditures more effectively.

Palo Alto, CaliforniaHeadquarters

2016Year Founded

$15.2MTotal Funding

SERIES_ACompany Stage

AI & Machine Learning, HealthcareIndustries

51-200Employees

Benefits

Medical, dental, & vision

Flexible work environment

Generous PTO

Competitive salary

Equity

401(k)

Sponsorship

Generous L&D Reimbursement policy

Risks

Integration challenges with Evolent Health could disrupt Machinify's operations.

Slow adoption of new technologies in healthcare may hinder Machinify's rapid deployment.

Reliance on a few large clients poses a risk if they switch providers.

Differentiation

Machinify leverages AI to optimize healthcare decision-making and administrative processes.

The company offers rapid deployment of AI applications for immediate ROI in healthcare.

Machinify's AI platform addresses the entire healthcare claims lifecycle efficiently.

Upsides

AI-driven automation in healthcare claims processing is gaining significant traction.

The healthcare AI market is projected to reach $45.2 billion by 2026.

Machinify's AI solutions reduce administrative costs and improve patient care access.

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