Healthcare Program Integrity Solutions Consultant

We need to output HTML fragment with sections: About the role? The description includes a paragraph about Commence. That could be "About the role" or maybe "Description". The instruction: use

for section headings (e.g. About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule). Use

• for any list of duties/requirements/benefits, and

  for prose. Do NOT repeat the job title as a heading (the page already shows it) and do NOT put Job ID / requisition numbers as headings — fold minor metadata into a short

  or drop it. Preserve ALL substantive information; do NOT invent or summarize away detail. Remove cookie/navigation/legal/EEO/equal-opportunity/scam-warning boilerplate, duplicated lines, and application instructions. IMPORTANT: include a section ONLY when the posting has real, specific content for it — never emit a heading followed by filler/placeholder text (e.g. "commensurate with experience", "not specified", "N/A", "varies", "TBD") and never create Pay/Schedule/Benefits sections unless the posting actually states them. Prefer a few substantive sections over many thin ones. We need to decide which sections to include. The posting includes: Description (intro paragraph), Requirements (actually includes responsibilities and domain expertise), Qualifications (including Bachelor's degree etc.), Preferred Qualifications, Work Environment/Physical Demands, Salary Description. We need to map to allowed headings: About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule. We have description: could be About the role. Responsibilities: we have many bullet-like paragraphs under "Payment Integrity & FWA Domain Expertise" and "Sales & Pre-Sales Support". Those are duties/responsibilities. So we can have a Responsibilities section with

  • items. Requirements: The posting has a "Requirements" heading then paragraphs describing role. But we already used Responsibilities for duties. The "Requirements" section in posting is more about role description; but we can treat that as part of About the role? However we have a separate Qualifications section for education/experience etc. The posting also has "Qualifications" heading with bullet list of qualifications. Then "Preferred Qualifications". Then "Work Environment/Physical Demands". Then "Salary Description". Also there is a line about remote eligible states. We need to avoid boilerplate like EEO etc. Remove that. We need to include Pay section because salary is given: $150,000.00-$175,000.00. So we can have Pay section with that. Schedule: Not mentioned; no schedule info. So we should not create Schedule section. Benefits: Not mentioned; no benefits listed. So we should not create Benefits section. Skills: Could we extract skills? There's mention of "Strong written and verbal communication skills", "Ability to travel", etc. Could be placed under Skills. But we already have Qualifications covering education/experience; Skills could be separate for soft skills. However we need to avoid thin sections. Perhaps combine skills into Qualifications or Responsibilities? The instruction: Prefer a few substantive sections over many thin ones. So maybe we include About the role, Responsibilities, Qualifications, Pay. Possibly also Work Environment? Could be included under About the role or Qualifications? But it's substantive; maybe we can include a Work Environment section? Not in allowed headings list; allowed headings are only those eight. So we cannot create a custom heading like Work Environment. We must use only those headings. So we need to fit work environment info into one of those headings. Perhaps About the role can include that paragraph. Or Qualifications can include it? But Qualifications is for education/experience. Better to put work environment details in About the role (description). The description already includes company overview; we can add work environment there. Thus sections: About the role (intro + work environment), Responsibilities (duties), Qualifications (education, experience, preferred qualifications maybe), Pay (salary). Possibly also Skills? But we can embed skills in Qualifications. We must not repeat job title. No metadata like Job ID. We must preserve all substantive information: need to include remote eligible states list, travel requirement, etc. Let's extract substantive content: - Company description paragraph: "At Commence, we’re the start of a new age of data-centric transformation, elevating health outcomes and powering better, more efficient process to program and patient health. We combine quality data-driven solutions that fuel answers, technology that advances performance, and clinical expertise that builds trust to create a more efficient path to quality care. With human-centered, healthcare-relevant, and value-based solutions, we create new possibilities with data. We provide proof beyond the concept and performance beyond the scope with a focus on efficiencies that transform the lives of those we serve. With a culture driven by purpose, straightforward communication and clinical domain expertise, Commence cuts straight to better care." - Responsibilities / domain expertise: Under "Payment Integrity & FWA Domain Expertise": bullet-like sentences: * Serve as the primary internal and external expert on commercial health plan payment integrity operations, including pre-payment review, post-payment recovery, SIU investigations, and provider fraud and billing scheme identification * Develop and maintain payment integrity-focused documentation, use cases, and enablement materials for Sales, Pre-Sales, and Customer Success teams * Partner with product management and engineering to ensure commercial payer payment integrity workflows and SIU operational realities are reflected in product design and roadmap decisions * Stay current on commercial payer fraud trends, payment integrity best practices, HIPAA compliance requirements, and regulatory changes that impact health plan program integrity operations * Identify new product opportunities based on emerging payment integrity trends, payer operational shifts, and evolving commercial health plan needs * Represent Commence's payment integrity expertise at industry forums, payer-facing events, and conferences to strengthen credibility and visibility in the commercial health plan market - Sales & Pre-Sales Support: * Partner with sales teams to provide payment integrity and FWA domain expertise throughout the commercial sales cycle from initial discovery through close * Help the sales team qualify and prioritize opportunities by identifying where Commence's platform creates the clearest operational fit and business value for commercial payer payment integrity departments * Conduct structured discovery conversations to understand a prospect's current payment integrity operations, SIU structure, pre- and post-payment review processes, and investigation challenges * Lead or participate in product demonstrations, serving as the domain voice that connects Commence's platform capabilities to the specific payment integrity workflows and SIU operations of each prospect * Support RFP and RFI responses requiring payment integrity domain knowledge and commercial health plan context - Qualifications: * Bachelor's degree in healthcare administration, public health, business, or a related field * Minimum of 5 years of hands-on experience in healthcare fraud, waste and abuse, payment integrity, or SIU operations within a commercial health plan, managed care organization, or health IT/analytics company serving commercial payers * Deep knowledge of commercial payer payment integrity operations including pre-payment clinical review, post-payment auditing and recovery, provider fraud patterns, billing scheme identification, claims analysis, and SIU case management * Demonstrated ability to translate operational payment integrity knowledge into practical technology use cases and client-facing solution narratives, not just describe how the payer world works, but show how technology changes it * Strong written and verbal communication skills with the ability to engage credibly with SIU analysts, payment integrity directors, compliance officers, and C-suite payer stakeholders * Ability to travel within the United States on a monthly basis - Preferred Qualifications: * Prior experience in a client-facing, solutions consulting, or vendor-facing role within a healthcare technology, analytics, or payment integrity company * Experience working with commercial payer procurement, vendor evaluation, and technology adoption cycles from either the buyer or seller side * Familiarity with fraud detection platforms, payment integrity solutions, case management tools, or clinical review technologies used in commercial payer environments * Certified Fraud Examiner (CFE), Certified in Healthcare Compliance (CHC), or similar credential * Commence' headquarters are in Virginia Beach, VA, however we are open to remote candidates in the following states: AZ, AR, DE, FL, GA, IL, IN, KS, KY, MA, MD, MI, MS, MO, MT, NC, NE, NV, NY, OH, OK, PA, SC, TN, TX, VA, DC, WI, and WV* - Work Environment/Physical Demands: paragraph about office/remote, climate-controlled, sitting, reading, computer, occasional stand/walk etc. Also EEO statement (remove). Also accommodation contact (remove). Also "Commence.AI is committed..." (remove). Also "Please note that unless you are requesting an accommodation, all applications must be submitted through our online application system." (remove). Also "Commence is an equal employment opportunity for employer." (remove). Also "All personnel processes are merit-based..." (remove). So we keep only the substantive work environment description: "This is an office/remote position. While performing the duties of this job, the employee regularly works in a climate-controlled environment. Candidates must be able to sit, read, work on a computer, and watch a computer screen for extended periods of time. Occasionally required to stand, walk, use hands and fingers, kneel or crouch." - Salary Description: "$150,000.00-$175,000.00" Now we need to output HTML fragment with headings

    and content. We need to decide which sections to include: About the role (intro + work environment), Responsibilities (combined domain expertise + sales support), Qualifications (education/experience + preferred qualifications maybe), Pay (salary). Could also include Skills but we can embed. We must not create empty sections. Let's craft:

    About the role

    At Commence, we’re the start of a new age of data-centric transformation, elevating health outcomes and powering better, more efficient process to program and patient health. We combine quality data-driven solutions that fuel answers, technology that advances performance, and clinical expertise that builds trust to create a more efficient path to quality care. With human-centered, healthcare-relevant, and value-based solutions, we create new possibilities with data. We provide proof beyond the concept and performance beyond the scope with a focus on efficiencies that transform the lives of those we serve. With a culture driven by purpose, straightforward communication and clinical domain expertise, Commence cuts straight to better care.

    This is an office/remote position. While performing the duties of this job, the employee regularly works in a climate-controlled environment. Candidates must be able to sit, read, work on a computer, and watch a computer screen for extended periods of time. Occasionally required to stand, walk, use hands and fingers, kneel or crouch.

    Responsibilities

    • Serve as the primary internal and external expert on commercial health plan payment integrity operations, including pre-payment review, post-payment recovery, SIU investigations, and provider fraud and billing scheme identification
    • Develop and maintain payment integrity-focused documentation, use cases, and enablement materials for Sales, Pre-Sales, and Customer Success teams
    • Partner with product management and engineering to ensure commercial payer payment integrity workflows and SIU operational realities are reflected in product design and roadmap decisions
    • Stay current on commercial payer fraud trends, payment integrity best practices, HIPAA compliance requirements, and regulatory changes that impact health plan program integrity operations
    • Identify new product opportunities based on emerging payment integrity trends, payer operational shifts, and evolving commercial health plan needs
    • Represent Commence's payment integrity expertise at industry forums, payer-facing events, and conferences to strengthen credibility and visibility in the commercial health plan market
    • Partner with sales teams to provide payment integrity and FWA domain expertise throughout the commercial sales cycle from initial discovery through close