Manager - Payment Integrity Operations

Departmental Position Summary:

The Manager Payment Integrity Operations is pivotal in managing the performance (planning, forecasting, reporting) of Payment Integrity functions. This role is essential for capturing benefit cost savings across the Enterprise while controlling and containing administrative expenses. The manager will oversee the financial performance of programs that deliver significant Enterprise Medical Expense savings, vital for enhancing Enterprise Underwriting performance.

Responsible for planning, organizing and managing an assigned business unit.  Operate within broad objectives to ensure optimum utilization of resources; adapt business unit plans and priorities to address resource and operational challenges. Evaluate policies, procedures and business unit goals to make decisions and solve problems.

• Manage activities of a department including, but not limited to planning, problem solving, staff development and communication.
• Manage the evaluation of new and existing business processes to identify areas of opportunity and execute on business unit objectives, supporting continuous improvement.
• Lead, direct, evaluate and develop the work of assigned employees.
• Responsible for special projects, programs and initiatives to ensure successful delivery of business outcomes.
• Provide effective and efficient solutions to complex business problems
• Ensure that day to day business unit operations align with organizational objectives.

Departmental Responsibilities:

• Develop and implement Payment Integrity value management processes to support internal financial reporting and facilitate corporate budgeting, forecasting, and planning.
• Lead the preparation of accurate budgets and forecasts that reflect future performance projections of Payment Integrity programs.
• Identify and integrate tools to enhance internal and external reporting and analytics.
• Oversee the development and refinement of tools and methodologies necessary for supporting the functional scope of work.
• Evaluate existing Payment Integrity capabilities to accurately determine the ROI for each service.
• Monitor performance against national benchmarks and manage ongoing vendor relations, including contract oversight, invoicing, and payments.
• Collaborate with Procurement to assess vendors, ensuring that financial impacts are transparent and support strategic business decisions.
• Manage the operational aspects of the Payment Integrity buy-up programs, including leakage detection, corrective actions, process documentation, and continuous improvement initiatives. Provide detailed reports to Business Units to identify opportunities for market penetration and margin contribution.
• Offer accounting and finance guidance to Payment Integrity staff, ensuring adherence to GAAP and company policies in expense and cost management.
• Serve as a key liaison among Payment Integrity, Actuary, Finance, Health Care Value, and Business Unit stakeholders.
• Create and refine presentation materials for both internal and external stakeholders, effectively communicating the Payment Integrity value proposition.
• This role requires a strategic leader capable of translating complex data into actionable insights and compelling narratives for Enterprise executives, thereby driving informed decision-making and robust financial health.

"Qualifications"

• Bachelor's Degree in a related field is required.  Master's Degree in a related field is preferred. 
• Five (5) years of experience in a related field is required.
• Previous experience leading projects and/or teams is required.
• Ability to effectively lead, coach and develop team members.
• Ability to work effectively in a team environment.
• Strong organizational, planning, analytical, and problem-solving skills.
• Working knowledge of corporate organizational structures, including functional responsibilities.
• Strong verbal, written communication and interpersonal skills.
• Ability to manage multiple priorities concurrently.
• Ability to solve practical problems and deal with moving variables in situations with limited standardization and alignment.
• Ability to interface and present to all levels of the organization.  
• Ability to build relationships and work collaboratively with cross-functional teams.

Departmental Preferences:

• Five (5) years in financial leadership roles, demonstrating progressive responsibility is preferred.
• Extensive expertise in Generally Accepted Accounting Principles (GAAP) and sophisticated Financial Planning & Analysis (FP&A) techniques is preferred.
• Profound understanding of forecasting methods and ratio analysis is preferred.
• Advanced proficiency in Microsoft Office Suite (Excel, Word, Visio, PowerPoint, Access) and familiarity with Oracle Cloud or similar enterprise financial systems is preferred.
• Advanced analytical and problem-solving skills, with a keen attention to detail is preferred.
• In-depth knowledge of corporate organizational structures and functional responsibilities is preferred.

All qualified applicants will receive consideration for employment without regard to, among other grounds, race, color, religion, sex, national origin, sexual orientation, age, gender identity, protected veteran status or status as an individual with a disability.