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, translating findings into corrective action plans
Serve as a subject matter expert on claim identification and recovery processes
Support client-driven and third-party audit initiatives by reviewing, analyzing, and reporting on recovery accuracy
Evaluate provider contract audit language and recommend enhancements
Analyze trends, exclusions, and provider behaviors to quantify financial impact
Develop and deliver clear, actionable reporting for leadership, providers, vendors, and external stakeholders
Enable vendor success through education on systems, procedures, and evolving recovery requirements

High School Diploma or G.E.D. required
3+ years of experience in payment integrity, provider relations, claims operations, or related healthcare analytics roles
2+ years of hands-on experience with healthcare claim systems such as PROCLAIM and FACETS
Working knowledge of healthcare claim processing and recovery workflows
Experience partnering across matrixed teams including Network, Legal, Contracting, Sales, and Operations
Strong analytical and organizational skills
Demonstrated ability to manage complex issues with appropriate urgency and sound judgment
Proficiency in Microsoft Word and Excel

Business Project Lead Analyst – Payment Integrity

Key skills