Job Description
We were tired of hearing that healthcare is broken, so we decided to do something about it. At Nomi Health, we believe the care itself isn’t broken — it’s the business of healthcare that gets in the way. Every year, more than $1 trillion is wasted on paperwork, delays, and middle layers that drive up costs and keep people from the care they need.
We’re rebuilding the system so it works the way it should: clear prices you can trust, faster payments that keep providers focused on patients, and data that helps employers make better decisions. Our work has already touched more than 30 million lives — from local communities in Michigan to some of the largest companies in the country.
What You’ll Do:
- Market solution design. Partner with network, go-to-market, and sales teams to define and scope what Nomi can realistically deliver in each new market before it’s sold, including provider coverage, TPA capability, and integration sequencing.
- Partner and TPA data exchange. Write the integration requirements between Nomi and every partner in the claim lifecycle — inbound claims, priced output, remittance, eligibility, file cadence, SLAs, and reconciliation — specific enough that an engineer on either side can build to it.
- Network configuration and pricing. Own the path from a signed rate sheet to a correctly priced claim: ingestion, normalization, versioning, effective dating, validation, and audit. Set the testing and release bar for anything that touches pricing.
- Provider data, adequacy, and directory. Own the provider data model and hierarchy — sponsor, tax ID, billing NPI, service location — and make network adequacy and directory accuracy measurable rather than asserted.
- New segments and group types. Evaluate new group types and segments as they come up, be willing to recommend against ones that don’t fit, and defend that recommendation to sales.
- The payments interface. Recognize when a network change has payment-side consequences and get ahead of it with the financial services and payments teams before it ships.
What We’re Looking For:
- Reimbursement fluency. You understand the difference between billed, allowed, and paid, and you’ve worked hands-on with real fee schedules and rate methodologies, percent-of-Medicare, per diem, case rate, DRG, percent-of-charge.
- Domain background. You’ve built this expertise at a health plan, a TPA, a repricing or payment-integrity vendor, a reference-based-pricing administrator, a provider revenue-cycle organization, or a network contracting organization.
- Data exchange experience. You’re comfortable with 837, 835, and eligibility file exchange, and you’ve written integration requirements that another team was able to build from successfully.
- Commercial confidence. You’re comfortable representing Nomi directly in front of a broker, a TPA executive, or a health system, and making commitments you can stand behind.
- A self-directed approach. You’re comfortable defining your own priorities and figuring out what matters most, rather than working off a pre-built roadmap.
- Enough technical fluency to be credible. You can read a data model, write SQL against it, and give an engineer clear enough direction that they’re not left guessing. You won’t be writing production code yourself.
- Strong written communication. Requirements documents are a core part of this role, so your writing should be clear, specific, and easy for others to build from.
Preferred Experiences:
- Experience in self-funded employer health: TPA administration, direct contracting, reference-based pricing, or captives.
- You’ve run a platform migration or a vendor claims-system implementation and lived through the reporting gap that follows.
- Founder or early-operator background, or a track record of using automation and AI to replace manual operational work.
Nomi Health delivers disruptive healthcare solutions, in partnership with like-minded employers, public sector organizations, advisors (brokers/consultants), and payers/TPAs. We’re a team of 300+ people who show up every day with the same mindset: don’t settle for “that’s just how it is.” Real change happens when you challenge the system, cut through the excuses, and build something better together.
