Payment Integrity Specialist

Council Capital • Nashville, TN

4d • $75,000 - $80,000 • Remote

About The Position

Alivia Analytics is a fast-growing healthcare technology company helping commercial and government payers fight fraud, waste, and abuse (FWA). Our AI-driven platform, Alivia 360, delivers payment integrity and measurable financial recoveries across the healthcare ecosystem. As a standalone SaaS company, we operate in a metrics-driven environment where sharp analysis turns directly into dollars recovered for our clients.
We are scaling our audit and payment integrity team to support new and expanding payer engagements. This role sits at the center of how we generate value: finding the improper payments others miss.

Requirements

• 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 (commercial, FEP, Medicaid, Medicare); breadth is preferred over depth in a single line.
• Strong analytical instincts: you find the significant problem in the data and work it to root cause.
• Comfort with Excel and general software; you learn new claims systems quickly (system-specific training is provided per client).
• A track record of hitting metric-driven, time-bound goals and staying composed under a monthly target.
• High integrity and sound judgment; you make the call on findings and stand behind them.
• Self-direction and ownership; you do not need to be managed through your queue.
• Authorized to work in the U.S. and U.S.-based (this role handles PHI and cannot be performed offshore).

Nice To Haves

• Prior payment integrity auditing specifically (vs. general claims auditing).
• Experience generating audit concepts / recovery ideas

Responsibilities

• Audit payer claims across multiple lines of business (commercial, FEP, Medicaid, Medicare) to identify improper payments and recovery opportunities.
• Analyze claims data in depth to determine root causes of improper payments and build defensible audit findings.
• Meet or exceed a monthly dollars-identified goal once assigned to a client (goal is set per client and audit type; expect a ramp during onboarding).
• Maintain a high quality standard on all identified dollars, minimizing false positives so findings hold up under client review.
• Generate new audit concepts and recovery ideas from patterns you see in the data (target of at least one new concept per month).
• Support key stakeholders with on-time client deliverables, including audit results and documentation.
• Apply payment integrity and claims-processing knowledge across different payers and claim systems as engagements shift.
• Contribute to the team's shared knowledge (trends, methods, and audit playbooks) as our capabilities grow.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed