Senior Lead Payment Integrity
About The Position
The Senior Lead is responsible for the end-to-end performance, satisfaction, and operational excellence of the company’s carrier network. The role develops and strengthens strategic carrier relationships while ensuring accuracy, compliance, service quality, and a positive carrier experience. As the primary liaison between carriers and internal teams, the Senior Lead drives alignment, transparency, and continuous improvement across communication, operations, payment processes, and partnership programs. The position oversees payment operations, quality assurance, carrier engagement, and experience management. It initiates and maintains savings and performance improvement initiatives with carrier partners, identifies opportunities to improve operations and reduce friction, and provides analytical insights and performance reporting for internal and external business reviews. The Senior Lead represents the organization in client- and carrier-facing discussions. The role also collaborates with IT and cross-functional teams to enhance tools, processes, and technology affecting carriers and the carrier engagement team. It champions operational integrity, strengthens partnerships, and drives data-informed improvements to support a seamless, reliable, and transparent experience for carriers, partners, and internal stakeholders.
Requirements
- Bachelor’s degree in business, operations, or a related field.
- Payor or carrier experience.
- 5–10+ years of experience in payment integrity operations, financial operations, or quality management.
- Experience managing payment integrity operations processes, workflow patterns, and complex operational programs.
- Strong analytical, problem-solving, and process-improvement skills.
- Strong relationship-building and communication skills.
- Ability to navigate, understand, and explain claims and billing data.
- Some combination of coding, medical records, or carrier payment integrity work.
- Ability to interpret large data sets and use them to drive decisions.
- Excellent organizational and project management abilities.
- Ability to navigate complex issues with diplomacy and accountability.
Nice To Haves
- Advanced degree preferred.
- Experience managing external partners or vendors preferred.
Responsibilities
- Attend monthly business review meetings with clients and provide detailed analytical insights about carrier engagement.
- Attend monthly carrier meetings, present referral findings, and lead data-driven discussions.
- Facilitate feedback loops to understand carrier needs and drive continuous improvement.
- Deliver the carrier experience vision, standards, and service models hands-on.
- Lead initiatives that strengthen trust, transparency, and partnership with carriers.
- Identify performance gaps and lead cross-functional improvement plans.
- Manage escalations and ensure timely resolution of carrier issues.
- Champion a consistent, high-quality experience across carrier and client touchpoints.
- Serve as an executive liaison for carrier and client relationships, focusing on service, performance, and partnership.
- Develop team capabilities in communication, analytics, relationship management, and problem-solving.
- Provide analytical insights and performance reporting during internal and external business reviews.
- Collaborate with IT and cross-functional teams to improve tools, processes, and technology affecting carriers and the carrier engagement team.
- Initiate and maintain savings and performance improvement initiatives with carrier partners.
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What This Job Offers
Job Type
Full-time
Career Level
Senior
