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Tier-1 brand, metro hiring, and mid-level seniority create high candidate competition.
Requires deep US payer, claims, and coding expertise, limiting cross-industry transferability.
Explicit 6-15+ years, payer-specific experience, and analytics requirements make shortlisting stringent.
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Lead and manage payment integrity programs focusing on healthcare payer clients to identify and recover claim overpayments and ensure payment accuracy.
Design and implement pre-payment and post-payment claim editing strategies and drive automation and AI-enabled payment integrity solutions to optimize costs.
Manage client relationships, present insights and recommendations, support product development, and lead cross-functional teams including mentoring analysts and consultants.
6 to 15+ years of experience in healthcare consulting, payment integrity, claims operations, or payer analytics.
Bachelor's degree required; Master's or MBA preferred.
Strong knowledge of U.S. healthcare payer ecosystem, claims processing, reimbursement methodologies, and coding systems (ICD-10, CPT, HCPCS, DRG).
Experience with analytical tools such as SQL, Excel, and visualization tools (Power BI/Tableau); familiarity with AI/ML is a plus.
Experienced leader capable of managing strategic initiatives and cross-functional teams in healthcare payment integrity.
Familiar with U.S. health plans and healthcare services organizations, well-versed in client relationship management and consulting.
Strong analytical mindset with ability to leverage data tools and collaborate across clinical, operations, analytics, and technology teams.