Payment Integrity Specialist – Strategic Initiatives

About the role

The Payment Integrity Specialist leads business case development for proposed initiatives, supports strategic planning and leads larger-scale, cross-functional initiatives aimed at performance improvement, financial gains, customer satisfaction and better compliance. The role covers organizing work teams, driving consensus and ensuring end-to-end policy and process integrity.

Key responsibilities

• Lead business case development so opportunities, risks and return on investment are adequately assessed.
• Support planning and prioritization of initiatives within the strategic and business planning process, ensuring they align with the strategic business plan and key objectives.
• Ensure approved business cases are transitioned to initiatives, with clear documentation and responsibilities.
• Organize work teams, establish project plans, facilitate meetings, build consensus, document recommendations and oversee implementation.
• Analyze data, workflows, policies, procedures, staff organization and skills to execute initiatives.
• Use project management software such as Excel, PowerPoint, Visio and Microsoft Project.
• Lead staff responsible for initiatives in the operating plan and assist other project leaders where needed.
• Write and deliver communications across the organization to support awareness and effectiveness of process improvement initiatives.

Required profile

• Bachelor's degree in a related field or equivalent experience; Master's degree preferred.
• 6+ years managing projects required.
• PMP (PMI) certification required; process quality certification preferred.
• Healthcare and/or insurance experience preferred.
• For Health Net and Enterprise Business Operations roles, PMP for Health Net and Enterprise Business Operations is preferred.

Required skills

• Project management software: Excel, PowerPoint, Visio, Microsoft Project
• PMP certification

What we offer

• Pay range of $87,700 to $157,800 per year, adjusted for skills, experience and other factors.
• Health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays.
• Flexible work arrangements: remote, hybrid, field or office schedules.