Director of Payment Integrity Strategy

A company is looking for a Director of Payment Integrity Strategy to lead the development of internal payment integrity capabilities. Key Responsibilities Act as a strategic leader for payment integrity, shaping internal approaches to pre-pay, post-pay, recovery, and fraud, waste, and abuse (FWA) related use cases Collaborate with Product, Engineering, Analytics, and Delivery teams to guide the design and evolution of payment integrity capabilities and workflows Translate complex payment integrity findings into clear insights and recommendations for internal stakeholders and leadership Required Qualifications Bachelor's degree in a related field or equivalent work experience 10+ years of experience in healthcare payer environments with expertise in payment integrity and claims analytics Prior experience in healthcare technology or analytics platforms Deep hands-on experience in pre-pay, claim audit, and medical coding/auditing Strong understanding of CMS and state-level regulatory policies and payer operations