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Niche US healthcare payment integrity skills but metro location and recognizable parent brand make it moderately competitive.
Requires specialized US payer, claims and coding knowledge, making skills less transferable across industries.
Explicit 6–15 years plus domain-specific payment integrity and US payer experience increases shortlisting rigor.
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Own and lead payment integrity programs to identify and recover healthcare claim overpayments, ensuring payment accuracy and cost optimization.
Analyze medical and pharmacy claims for billing errors, fraud, waste, abuse, and contract compliance; design and implement pre-payment and post-payment claim editing strategies.
Collaborate with cross-functional teams and manage client relationships to drive automation, AI-enabled solutions, and achieve KPIs like savings, accuracy, audit yield, and provider abrasion.
6 to 15+ years of experience in healthcare consulting, payment integrity, claims operations, or payer analytics.
Bachelor's degree required; Master's/MBA preferred.
Strong knowledge of U.S. healthcare payer ecosystem, claims processing, reimbursement methodologies, and coding systems (ICD-10, CPT, HCPCS, DRG).
Job location options: Bangalore, Hyderabad, or Gurugram.
Experienced in working with U.S. health plans or healthcare services organizations with proven expertise in payment integrity and claims analytics.
Strong command over stakeholder management, consulting, and strategic initiative leadership with ability to manage cross-functional teams.
Technically proficient with analytical tools (SQL, Excel, Power BI/Tableau) and familiarity with AI/ML-driven payment integrity solutions.