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ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
payment integrityclaims lifecyclefraud preventionwaste preventionabuse preventionoperational KPIsclaims configurationregulatory compliancefinancial yieldsvendor management
Soft Skills
leadershipstrategic thinkinganalytical skillsfinancial acumenoperational acumencollaborationcontinuous improvementmentoringaccountabilitysuccession planning
Industry Keywords
healthcare claimspayment integrity operationsaudit requirementsindustry best practiceshigh-growth environmentscomplex environmentsmulti-vendor portfoliosavings trackingprovider abrasioninternal capabilities
About the role
Key responsibilities & impact- Lead payment integrity strategy and execution, including pre- and post-payment reviews, fraud, waste, and abuse (FWA) prevention, and recovery efforts
- Design and lead solutions to address leakage throughout the claims lifecycle, including developing internal capabilities and implementing external vendor programs
- Assess the current payment integrity program ecosystem and prioritize opportunities to deliver additional savings
- Build and manage a high-performing multi-vendor portfolio, enforcing rigorous SLAs and optimizing contingency fee structures to maximize financial yields while actively mitigating provider abrasion
- Provide executive leadership over all payment integrity operations, ensuring high performance of all internal and external PI programs
- Lead strategy and execution to insource payment integrity opportunities as appropriate
- Establish and monitor savings and operational KPIs
- Develop, scale and optimize payment integrity operations to support business growth, new products, and regulatory requirements
- Partner with Finance and Med Econ to ensure detailed savings tracking of payment integrity initiatives
- Build, mentor, and lead a high-performing leadership team with a strong culture of accountability, collaboration, and continuous improvement
- Build strong leadership and career pathways within the organization to support retention and succession planning
Requirements
What you’ll need- 15+ years of progressive leadership experience in healthcare claims or payment integrity operations
- Deep expertise in medical claims operations, payment integrity, claims configuration, and regulatory compliance
- Proven experience scaling operational organizations in high-growth or complex environments
- Strong understanding of healthcare regulations, audit requirements, and industry best practices
- Demonstrated ability to lead large, distributed teams and manage complex vendor relationships
- Strategic thinker with strong analytical, financial, and operational acumen
Benefits
Comp & perks- Health insurance
- 401k program
- Flexible PTO
- Up to 16 weeks paid parental leave
- Paid holidays
- Cell phone reimbursement
- Transportation perks
- Education reimbursement
- 1 week of paid paw-ternity leave