Senior Lead Payment Integrity

Position Overview

The Senior Lead of Payment Integrity is responsible forthe endtoend performance satisfaction and operational excellence of the companys carrier network. This role develops manages and strengthens strategic carrier relationships while ensuring accuracy compliance service quality and a consistently positivecarrierexperience. Acting as the primary liaison between carriers and internal teams the Senior Lead drives alignment transparency and continuous improvement across communication operations payment processes andpartnership programs.

This position oversees key functions including payment operations quality assurance carrier engagement and experience management. The Senior Lead initiates andmaintainssavings and performanceimprovement initiatives with carrier partnersidentifyingopportunities for operational enhancements and friction reduction. The role also provides analytical insights and performance reporting during internal and external business reviewsrepresentingthe organization in client and carrierfacing discussions.

Additionally the Senior Lead collaborates closely with IT andcrossfunctionalteams to enhance tools processes and technologyimpactingcarriers and the carrier engagement team. By championing operational integrity strengthening partnerships and driving datainformed improvements this role ensures a seamless reliable and transparent endtoend experience for carriers partners and internal stakeholders while supporting organizational growth.

Responsibilities

• Attendmonthly Business Review meetings with clients providing detailed and analytical data insights as it relates to carrier engagement.

• Attend monthly Carrier meetingsproviding referral findings and leading data-driven discussion

• Facilitate feedback loops to understand carrier needs and drive continuous improvement

• Hands-on delivery of the carrier experience visionstandardsand service models

• Leadinitiatives that strengthen trust transparency and partnership with carriers

• Identifyperformance gaps and lead crossfunctional improvement plans

• Manageescalations and ensuretimelyresolution of carrier issues

• Champion aconsistent highquality experience across all carrierand clienttouchpoints

• Serve as an executive liaison for carrier and client relationships focusing on serviceperformanceand partnership

• Develop team capabilities in communication analytics relationship management and problem-solving

Qualifications

• Bachelors degree inbusiness operations or related field; advanced degree preferred

• Payor/Carrier experience isrequired

• 5- 10 years of experience in paymentintegrityoperations financial operations or quality management

• Experience managingthe payment integrity operations process workflowpatternsandcomplex operational programs

• Experience managing external partners or vendors preferred

• Strong analytical problemsolving and processimprovement skills

Skills & Competencies

• Strong relationshipbuilding and communication skills

• Ability to navigate understand and explain claims and billing data

• Some combination of coding/medical records or carrier payment integrity work

• Analytical mindset with the ability to interpretlargedatasetsand drive decisions

• Excellent organizational and project management abilities

• Ability to navigate complex issues with diplomacy and accountability

Success Indicators

• Carriers consistently meet or exceed performance expectations

• Strong collaborative relationships withcarriersand internal teams

• Reduced escalations and improved issueresolution timelines

• Clear consistent communication and documentation across all carrier interactions

• Measurable improvements in carrier satisfaction and operational efficiency

Who isSmartLightAnalytics

SmartLightAnalytics was formed by a group of industry insiders who wanted to make a meaningful impact on the rising cost of healthcare. With this end in mindSmartLightworks for self-funded employers to reduce wasteful spending in their healthcare plan through our proprietary data analysis. Our process works behind the scenes to save money without interrupting employee benefits or requiring employee behavior changes.