Senior Lead Payment Integrity (Healthcare)

TL;DR

Senior Lead Payment Integrity (Healthcare Finance): Overseeing the end-to-end performance and operational excellence of the carrier network with an accent on payment operations, compliance, and strategic partnership management. Focus on analyzing claims data to drive operational enhancements, resolving complex carrier escalations, and implementing performance improvement initiatives.

Company

hirify.global utilizes proprietary data analysis to help self-funded employers reduce wasteful healthcare spending without affecting employee benefits.

What you will do

• Manage end-to-end performance, satisfaction, and operational excellence of the company’s carrier network.
• Lead monthly Business Review meetings with clients and carriers, providing detailed analytical data insights.
• Develop and execute the carrier experience vision, standards, and service models.
• Identify performance gaps and lead cross-functional improvement plans to reduce friction.
• Manage high-level escalations and ensure timely resolution of carrier issues.
• Collaborate with IT and cross-functional teams to enhance technology and tools impacting carrier engagement.

Requirements

• Bachelor’s degree in business, operations, or a related field.
• 5-10+ years of experience in payment integrity operations, financial operations, or quality management.
• Mandatory experience working with Payors or Carriers.
• Proven track record of managing complex operational programs and workflow patterns.
• Strong ability to navigate and interpret large claims and billing data sets.
• Experience managing external partners or vendors.

Nice to have

• Advanced degree in a relevant field.
• Practical experience with medical coding or reviewing medical records.