Director of Payment Integrity

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SmartLight Analytics

WebsiteLinkedInAll Job Openings

1 - 10 employees

Founded 2016

⚕️ Healthcare Insurance

💳 Fintech

Healthcare Insurance • Fintech • Data Services

SmartLight Analytics is a healthcare analytics company that provides independent and ongoing monitoring of employee healthcare claims data. They focus on identifying and eliminating wasteful spending within health plans, ultimately lowering healthcare costs for self-funded employers without requiring changes in employee behavior. With a team of experts in data analysis, healthcare, and fraud investigation, SmartLight Analytics aims to improve healthcare benefits and promote high-value care for its clients while ensuring compliance with healthcare regulations.

📋 Description

• 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

🎯 Requirements

• 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

🏖️ Benefits

• None stated