Manager, Payment Integrity Insights & Innovation (Healthcare)

Location: Remote-MO, United States

Salary: $87,700–$157,800 per year

Company

hirify.global is a national healthcare organization serving 28 million members.

What you will do

• Develop, implement, and manage strategic fraud, waste, and abuse activities.
• Monitor business processes and systems for billing, claims payment integrity, and compliance.
• Lead analysts investigating potential fraud, waste, and abuse referrals.
• Create customized fraud plans, educational materials, and policies aligned with contractual and federal requirements.
• Present the fraud, waste, and abuse program to state and federal personnel and participate in required meetings.
• Review post-payment cases, obtain refunds, and prepare monthly and quarterly savings reports.

Requirements

• Bachelor’s degree in business, healthcare, criminal justice, a related field, or equivalent experience.
• At least 4 years of medical claims investigation, compliance, or fraud and abuse experience.
• Thorough knowledge of medical terminology.
• Experience in a managed care environment and leading or supervising staff is preferred.
• Medical records or coding license is preferred.
• Work from Missouri is indicated by the Remote-MO location.

Culture & Benefits

• Health insurance and comprehensive employee benefits.
• 401(k) and stock purchase plans.
• Tuition reimbursement.
• Paid time off and holidays.
• Flexible work arrangements, including remote, hybrid, field, or office schedules.