Director, Healthcare - Payment Integrity

West Monroe•Washington, DC

11h•$200,000 - $250,000•Onsite

About The Position

West Monroe has an immediate opportunity for a Director aligned to the Healthcare Practice. This role will focus on delivering business and technology consulting solutions for payer organizations, with a specialization in Payment Integrity, claims operations, reimbursement methodologies, and healthcare finance transformation. Working alongside leaders across our National Healthcare Practice, this role will be responsible for developing and growing client relationships, identifying and pursuing new business opportunities, leading complex consulting engagements, and delivering exceptional value to clients. Candidates should be passionate about healthcare transformation, client service, and working in a collaborative, entrepreneurial environment.

Requirements

Bachelor's degree required; advanced degree preferred.
10+ years of consulting, healthcare payer, or healthcare operations experience with significant exposure to Payment Integrity, claims operations, reimbursement, and recovery programs.
Demonstrated experience leading complex client engagements and managing executive-level stakeholder relationships.
Proven ability to identify, develop, and support new business opportunities within existing and prospective accounts.
Strong understanding of healthcare payer operations, claims processing, reimbursement methodologies, provider payment models, and Payment Integrity programs.
Experience leading business and technology transformation initiatives within health insurance organizations.
Strong program and project management experience, including scope, budget, risk, issue, and stakeholder management.
Excellent verbal, written, and executive presentation skills.
Demonstrated ability to mentor and develop team members.
Commitment to fostering an inclusive culture and embracing diverse perspectives.

Responsibilities

Develop and expand relationships with payer organizations, including medical and ancillary insurers.
Serve as a trusted advisor to client executives by bringing deep expertise in Payment Integrity, claims processing, reimbursement recovery, and provider revenue cycle operations.
Identify and originate opportunities within existing and prospective client accounts.
Participate in business development activities including client meetings, industry events, networking, and proposal development.
Support the sales cycle by helping shape solutions, work plans, pricing approaches, and value propositions.
Leverage market insights and industry expertise to position West Monroe as a trusted advisor and thought leader.
Collaborate with Healthcare Practice leadership, Business Development, and Marketing teams to support go-to-market activities and client growth initiatives.
Contribute to account growth through cross-selling and expansion of existing client relationships.
Serve as an engagement leader on Payment Integrity and payer transformation engagements.
Manage all aspects of client delivery including scope, budget, staffing, workstreams, deliverables, and overall engagement profitability.
Provide strategic and operational guidance to clients on Payment Integrity programs, claims operations, reimbursement methodologies, and recovery optimization.
Communicate project status, risks, recommendations, and outcomes to executive stakeholders.
Ensure value creation is identified, measured, and articulated throughout the engagement lifecycle.
Mentor and develop consulting teams while maintaining high standards of quality and client service.
Act as a point of escalation for client concerns and drive issues through resolution.
Apply deep industry expertise to solve complex client challenges and deliver measurable business outcomes.
Contribute to the growth and evolution of West Monroe's Healthcare Practice through knowledge sharing, thought leadership, and solution development.
Develop Payment Integrity methodologies, tools, and best practices that enhance client delivery.
Support recruiting, onboarding, and mentoring efforts across the practice.
Actively participate in performance management and career development of team members.
Foster a culture of collaboration, inclusion, innovation, and continuous improvement.
Contribute to thought leadership through industry participation, conference speaking opportunities, and market-facing content.