Healthcare Program Integrity Consultant

Commence

Consultant managing healthcare program integrity solutions for Commence while supporting customer success and sales teams. Bridging operational knowledge with technology in the commercial payer market.

Posted 7/27/2026full-timeRemote • Arizona, Florida, Illinois, Kansas, Kentucky, Maryland, Massachusetts, Mississippi, Missouri, Montana, Nevada, New York, North Carolina, Ohio, Oklahoma, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, Washington, West Virginia, Wisconsin • 🇺🇸 United StatesMid-LevelSenior💰 $150,000 - $175,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Expertise in healthcare fraud, waste and abuse, and payment integrity operations, with a strong ability to translate operational knowledge into technology-driven solutions for commercial payers. Proven communication skills to engage effectively with stakeholders at all levels, including C-suite executives.

Highest-signal resume keywords

Healthcare Fraud, Waste And AbusePayment Integrity OperationsSpecial Investigative Unit (SIU) FunctionsClaims AnalysisCommunication Skills

ATS Keywords

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Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Pre-Payment Clinical ReviewPost-Payment AuditingProvider Fraud PatternsBilling Scheme IdentificationSIU Case Management

Soft Skills

Written CommunicationVerbal Communication

Industry Keywords

Commercial PayerManaged Care OrganizationHealth ITAnalytics

About the role

Key responsibilities & impact

Play a significant role in the growth and success of Commence in the commercial payer market
Serve as a trusted authority on healthcare fraud, waste and abuse, payment integrity operations, and Special Investigative Unit (SIU) functions
Bridge operational knowledge with technology to assist prospective customers
Provide domain support during customer onboarding and implementation

Requirements

What you’ll need

Bachelor's degree in healthcare administration, public health, business, or a related field
Minimum of 5 years of hands-on experience in healthcare fraud, waste and abuse, payment integrity, or SIU operations within a commercial health plan, managed care organization, or health IT/analytics company serving commercial payers
Deep knowledge of commercial payer payment integrity operations including pre-payment clinical review, post-payment auditing and recovery, provider fraud patterns, billing scheme identification, claims analysis, and SIU case management
Demonstrated ability to translate operational payment integrity knowledge into practical technology use cases and client-facing solution narratives, not just describe how the payer world works, but show how technology changes it
Strong written and verbal communication skills with the ability to engage credibly with SIU analysts, payment integrity directors, compliance officers, and C-suite payer stakeholders
Ability to travel within the United States on a monthly basis

Benefits

Comp & perks

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