Lead Payment Integrity Systems Specialist

About the role

The Lead Payment Integrity Systems Specialist is a senior individual contributor and enterprise‑level subject‑matter expert responsible for governing payment integrity platforms, analytics, financial reporting and operational visibility. The role sets technical standards, leads cross‑platform analysis and advises leadership on strategic risks and improvement opportunities.

Key responsibilities

• Lead enterprise‑level analysis of payment integrity systems, claims, workflow and financial data to identify risks, savings and operational improvements.
• Define and enforce standards for technical review, data validation, dashboarding, reporting routines, ServiceNow intake and defect/enhancement prioritisation.
• Act as senior business‑technology liaison for platform change management, aligning Operations, Technology, Finance and governance stakeholders.
• Translate complex cross‑platform results into executive‑ready summaries, strategic recommendations and measurable success criteria.
• Provide technical leadership, coaching and escalation support to PI Systems Specialist team members.

Required profile

• Bachelor’s degree in healthcare, business, finance, accounting, information systems, data analytics or related field, or equivalent experience.
• 5+ years of experience with payment integrity systems, managed‑care claims platforms, platform governance, financial reporting or healthcare analytics.
• Demonstrated ability to lead technical direction, resolve precedent‑setting issues and influence senior leaders without formal authority.
• Advanced knowledge of financial systems and accounting principles is preferred.

Required skills

• Advanced proficiency with SQL.
• Experience with reporting/analytics tools such as Power BI and Excel.
• Familiarity with ServiceNow or similar ticketing/workflow platforms.
• Ability to create executive‑level data storytelling and dashboard/KPI development.
• Experience with UAT, regression testing, release readiness and defect/enhancement intake processes.

What we offer

• Competitive salary range $87,000 – $161,300 per year.
• Comprehensive benefits including health insurance, 401(k) and stock purchase plans.
• Tuition reimbursement, paid time off plus holidays.
• Flexible work arrangements – remote, hybrid, field or office options.