Payment Integrity Specialist

Job Summary

Auditing payer claims across multiple lines of business, the full-time remote Payment Integrity Specialist will identify improper payments, quantify recoveries, and generate new audit concepts while maintaining high-quality standards and meeting monthly financial goals.

Key responsibilities

• Audit payer claims to identify improper payments and recovery opportunities across various lines of business
• Analyze claims data to determine root causes of improper payments and build defensible audit findings
• Generate new audit concepts and recovery ideas based on patterns observed in the data

Required qualifications

• 2+ years of experience at a payer or a payment integrity/audit vendor
• Hands-on experience with claims processing and payment integrity auditing
• Exposure across multiple lines of business, including commercial, FEP, Medicaid, and Medicare
• Strong analytical skills with the ability to identify significant problems in data
• Proficiency with Excel and ability to quickly learn new claims systems