Risk Management Lead

About the role

For our client, we are seeking a Risk Management Lead to join the team of a leader in the Healthcare space. This role will lead claim payment error investigations, audit response activities, and corrective action planning across healthcare operations. You will partner with internal and external stakeholders to strengthen controls, translate contract requirements into operational practices, and support the resolution of high-dollar claims. The position also involves mentoring team members and helping drive implementation workplans for key initiatives. Location: Remote - US based candidates only, no visa sponsorship available.

Responsibilities

• Lead investigations into alleged claim payment errors for audits
• Train and mentor staff on audit preparation and documentation
• Document root causes of errors and support corrective action planning
• Collaborate with internal and external partners on audit findings
• Provide expertise on high-dollar claims and their resolution
• Translate contract requirements into operational processes and controls
• Develop implementation workplans for projects and initiatives

Qualifications

• 5+ years of experience in healthcare claims operations, audit, or compliance
• Strong knowledge of reimbursement methodologies for Institutional and Professional claims
• 2+ years of experience leading projects or teams
• Experience resolving claim payment errors and audit findings
• Proficiency in Microsoft Office, especially Excel, Word, and PowerPoint

Benefits

• Medical, dental, and vision benefits
• 401(k) retirement savings plan
• Paid time off and holidays
• Paid parental and caregiver leave
• Short-term and long-term disability insurance
• Life insurance and additional wellness opportunities

Pay

$104,000 – $143,000 annually