Payment Integrity Specialist

About Alivia Analytics

Alivia Analytics is a fast-growing healthcare technology company specializing in fighting fraud, waste, and abuse (FWA) through its AI-driven platform, Alivia 360. The company operates in a metrics-driven environment where sharp analysis leads to direct financial recoveries for clients. Alivia Analytics is scaling its audit and payment integrity team to support new and expanding payer engagements.

The Role

This role sits at the heart of how Alivia Analytics generates value: identifying improper payments others often overlook. As a Payment Integrity Specialist, you will audit payer claims across various lines of business, identify improper payments, and quantify the financial recoveries you achieve. This is an individual contributor role for someone energized by clear, measurable targets and proud of the accuracy of their findings. You will also contribute new audit concepts and recovery ideas from patterns observed in the data.

What You Will Do

• 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 You Bring

• 2+ years of experience at a payer or a payment integrity / audit vendor.
• Hands-on experience with claims processing and payment integrity auditing.
• Breadth across multiple lines of business (commercial, FEP, Medicaid, Medicare); preference for those with exposure to multiple lines.
• Strong analytical instincts: finding the significant problem in the data and working it to root cause.
• Comfort with Excel and general software; ability to quickly learn new claims systems (training provided per client).
• A track record of hitting metric-driven, time-bound goals and maintaining composure under a monthly target.
• High integrity and sound judgment; making calls on findings and standing behind them.
• Self-direction and ownership; not needing 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 Have

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

Compensation Range

$75K - $80K