Senior Lead Payment Integrity

Location: Remote

Company

hirify.global helps self-funded employers reduce wasteful healthcare spending through proprietary data analysis while preserving employee benefits.

What you will do

• Lead the end-to-end performance, satisfaction, and operational excellence of the carrier network.
• Manage carrier and client relationships, including monthly business reviews and data-driven carrier meetings.
• Drive feedback loops, service standards, partnership initiatives, and continuous improvements to the carrier experience.
• Identify performance gaps, lead cross-functional improvement plans, and manage escalations through timely resolution.
• Provide analytical insights and performance reporting on carrier engagement, payment operations, and operational efficiency.
• Collaborate with IT and cross-functional teams to improve tools, workflows, and technology supporting carrier engagement.

Requirements

• Bachelor’s degree in business, operations, or a related field; an advanced degree is preferred.
• Payor or carrier experience is required.
• 5–10+ years of experience in payment integrity operations, financial operations, or quality management.
• Experience managing payment integrity processes, workflow patterns, and complex operational programs.
• Strong analytical, problem-solving, process-improvement, relationship-building, and communication skills.
• Ability to interpret claims and billing data, analyze large data sets, and navigate complex issues with diplomacy and accountability.

Nice to have

• Experience managing external partners or vendors.
• Advanced degree.
• Experience with coding, medical records, or carrier payment integrity work.

Culture & Benefits

• Remote work arrangement.
• Focus on reducing healthcare waste without interrupting employee benefits or requiring changes in employee behavior.
• Work involving collaboration with carriers, clients, IT, and internal cross-functional teams.