Business Project Lead Analyst – Payment Integrity - Remote

Overview

This role plays a critical part in strengthening payment integrity outcomes by partnering with providers, vendors, and internal teams to drive accurate and timely recovery of provider overpayments.

In Short

• Lead strategic collaboration between recovery vendors, providers, and internal network partners.
• Drive monthly provider and vendor discussions to review overpayment inventory.
• Partner with Network and Contracting teams to address uncooperative providers.
• Monitor vendor performance and accuracy to improve results.
• Serve as a subject matter expert on claim identification and recovery processes.
• Support client-driven and third-party audit initiatives.
• Evaluate provider contract audit language and recommend enhancements.
• Analyze trends and provider behaviors to quantify financial impact.
• Develop and deliver clear reporting for stakeholders.
• Enable vendor success through education on systems and procedures.

Requirements

• High School Diploma or G.E.D. required.
• 3+ years of experience in payment integrity or related roles.
• 2+ years of hands-on experience with healthcare claim systems.
• Working knowledge of healthcare claim processing workflows.
• Experience partnering across matrixed teams.
• Strong analytical, organizational, and communication skills.
• Demonstrated ability to manage complex issues.
• Proficiency in Microsoft Word and Excel.
• Experience working directly with providers is preferred.
• Bachelor’s degree in a related field is preferred.

Benefits

• Comprehensive health-related benefits starting on day one.
• 401(k) and company paid life insurance.
• Tuition reimbursement.
• A minimum of 18 days of paid time off per year.
• Paid holidays.