Senior Director of Payment Integrity
About The Position
The Senior Director, Payment Integrity leads the enterprise function responsible for ensuring claims are paid accurately, appropriately, and in accordance with plan benefits, provider contracts, reimbursement policies, clinical guidelines, and regulatory requirements. This role is accountable for developing and executing strategies that prevent, detect, correct, and recover improper payments while reducing financial leakage, supporting cost containment, and improving operational quality. This leader oversees end-to-end payment integrity capabilities, including pre-payment accuracy, post-payment audit and recovery, clinical and coding review, reimbursement and payment policy, fraud, waste and abuse support, provider billing trend analysis, and payment integrity analytics. The role partners closely with Claims, Clinical, Provider Network, Finance, Compliance, Legal, Technology, Data Analytics, and external vendors to strengthen payment controls, improve claims administration, and support transparent provider and member experiences.
Requirements
- Requires background check.
- Proof of eligibility to work in the United States must be provided if selected for hire.
- Delta Dental will not sponsor applicants for work visas for this position.
Responsibilities
- Leads the enterprise function responsible for ensuring claims are paid accurately, appropriately, and in accordance with plan benefits, provider contracts, reimbursement policies, clinical guidelines, and regulatory requirements.
- Develops and executes strategies that prevent, detect, correct, and recover improper payments.
- Reduces financial leakage and supports cost containment.
- Improves operational quality.
- Oversees end-to-end payment integrity capabilities, including pre-payment accuracy, post-payment audit and recovery, clinical and coding review, reimbursement and payment policy, fraud, waste and abuse support, provider billing trend analysis, and payment integrity analytics.
- Partners closely with Claims, Clinical, Provider Network, Finance, Compliance, Legal, Technology, Data Analytics, and external vendors to strengthen payment controls, improve claims administration, and support transparent provider and member experiences.
Benefits
- Competitive base and incentive pay
- 401(k) with robust matching and non-matching contributions
- Rich medical & pharmacy benefits
- 100% employer-paid dental and vision benefits
- Holistic wellbeing program with deep financial incentives
- Generous paid time off plus 12 paid holidays and your birthday off
- Culture of growth and learning: career development; tuition reimbursement; recognition program
- Family support: adoption assistance, fertility treatment, child, elder & pet care assistance
- Social responsibility and volunteer opportunities
- Employee discount program
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What This Job Offers
Job Type
Full-time
Career Level
Director
Education Level
No Education Listed
