Director of Payment Integrity

Responsibilities

• Attend monthly Business Review meetings with clients providing detailed and analytical data insights as it relates to carrier engagement
• Attend monthly Carrier meetings providing referral findings and leading data-driven discussion
• Hands-on delivery of the client medical claims data to external and internal stakeholders
• 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 all 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

Qualifications

• Bachelor’s degree in business, operations, or related field; advanced degree preferred
• 5 - 10+ years of experience in payment integrity operations, clinical coding, or account management
• Experience managing the payment integrity operations process, workflow patterns and complex operational programs
• Strong data analytics, use of data visualization tools, relationship building, problem-solving, and process-improvement skills

About the Role

The Director of Carrier Engagement is responsible for the end-to-end performance, accuracy, and satisfaction of the company's Claims Administrators network. This role oversees payment operations, quality assurance, carrier engagement, and experience.

Who is SmartLight Analytics

SmartLight Analytics was formed by a group of industry insiders who wanted to make a meaningful impact on the rising cost of healthcare. With this end in mind, SmartLight works for self-funded employers to reduce wasteful spending in their healthcare plan through our proprietary data analysis. Our process works behind the scenes to save money without interrupting employee benefits or requiring employee behavior changes.