Act as a strategic leader for payment integrity across Abacus, shaping internal approaches to pre‑pay, post‑pay, recovery, and FWA‑related use cases.
Partner closely with Product, Engineering, Analytics, and Delivery teams to guide the design and evolution of payment integrity‑related capabilities, workflows, and analytical approaches.
Translate complex payment integrity findings, data patterns, and industry practices into clear insights, narratives, and recommendations for internal stakeholders and leadership.
Review and guide analytical methodologies to ensure accuracy, relevance, and alignment with payer operational realities.
Contribute to internal frameworks, playbooks, and documentation that enable consistent, scalable payment integrity practices across teams.
Serve as a thought partner to senior leaders on industry trends, regulatory considerations, and emerging payment integrity strategies.
Support internal enablement by sharing expertise, best practices, and lessons learned to raise organizational fluency in payment integrity.

Bachelor’s degree in a related field (e.g., healthcare administration, business, analytics, or similar) or equivalent work experience.
10+ years of experience in healthcare payer environments with deep expertise in payment integrity, claims analytics, overpayment identification, recovery, and FWA concepts.
Prior experience in healthcare technology, analytics platforms, or data‑enabled services.
Deep hands-on experience in pre-pay, claim audit/complex claim review, and medical coding/auditing.
Strong understanding of CMS and state-level regulatory policies and guidelines.
Strong understanding of payer operations and how payment integrity strategies translate into measurable financial and operational outcomes.
Able to apply business logic and subject matter expertise to translate payment integrity data sources into pre-pay and post-pay payment integrity solutions.
Experience partnering with Product, Engineering, Analytics, Sales, and Operations teams in a data‑driven technology or SaaS environment.
Strong communication and presentation skills.
Strategic mindset, intellectual curiosity, and comfort operating in a fast‑paced, growth‑oriented organization.

Director, Payment Integrity Strategy

Key skills