Director of Payment Integrity Strategy

Job Summary

A company is looking for a Director of Payment Integrity Strategy to lead the development of internal payment integrity capabilities.

Key Responsibilities

• Act as a strategic leader for payment integrity, shaping internal approaches to pre-pay, post-pay, recovery, and fraud, waste, and abuse (FWA) related use cases
• Collaborate with Product, Engineering, Analytics, and Delivery teams to guide the design and evolution of payment integrity capabilities and workflows
• Translate complex payment integrity findings into clear insights and recommendations for internal stakeholders and leadership

Required Qualifications

• Bachelor's degree in a related field or equivalent work experience
• 10+ years of experience in healthcare payer environments with expertise in payment integrity and claims analytics
• Prior experience in healthcare technology or analytics platforms
• Deep hands-on experience in pre-pay, claim audit, and medical coding/auditing
• Strong understanding of CMS and state-level regulatory policies and payer operations