Senior Manager - Payment Integrity

Sagility Limited; Hyderabad; On-site; INR 1,200,000 - 1,800,000; Full time

Job summary

Sagility Limited in Bangalore is looking for a Senior Manager - Payment Integrity to take charge of contract loading and ensure payment accuracy. The role includes strategizing and delivering training programs to clients and internal teams.

The ideal candidate should have over 7 years of experience in healthcare and claims adjudication, along with a strong analytical background. Knowledge of healthcare reimbursement systems and compliance regulations is essential.

Qualifications

• 7+ years of experience in healthcare and claims adjudication.
• 2+ years of experience in training is preferred.
• 3+ years of experience in Prepay/Post-pay Payment Integrity, Data Mining, or Contract Audit.

Responsibilities

• Serve as a domain expert in contract loading and ensure payment accuracy.
• Design and deliver training programs on healthcare processes.
• Identify gaps in workflows and propose solutions.

Skills

Contract rate loading

Healthcare payment processing systems

Analytical capabilities

Microsoft Excel

Communication skills

Education

Graduation or equivalent

Tools

Facets

TriZetto

Job description

Sagility combines industry-leading technology and transformation-driven BPM services with decades of healthcare domain expertise to help clients draw closer to their members. The company optimizes the entire member/patient experience through service offerings for clinical, case management, member engagement, provider solutions, payment integrity, claims cost containment, and analytics. Sagility has more than 25,000 employees across 5 countries.

Job Title

Senior Manager - Payment Integrity

Department

Payment Integrity

Job Summary

The Senior Manager will serve as a domain expert in contract loading, concept validation, and flagging discrepancies to ensure payment accuracy and integrity, while also leading training initiatives for internal teams and clients. This role involves providing strategic consulting, designing and delivering training programs, and ensuring operational excellence across teams. The manager will collaborate with stakeholders to implement best practices, optimize workflows, and drive transformation initiatives. The role demands strong analytical skills, attention to detail, and a deep understanding of claims processing and contract management systems.

Key Areas of Responsibility

• A. Contract Loading & Consulting

  Provide expertise in US healthcare regulations, payer‑provider processes, HIPAA compliance, and revenue cycle management. Review and update contract details including fee schedules, reimbursement rates, and payment terms to support accurate claims adjudication. Ensure timely and precise updates to contract data, reflecting the most current agreement terms and minimizing payment discrepancies. Support implementation of technology‑driven solutions for operational efficiency.

• B. Training & Development

  Design and deliver training programs for internal teams and client staff on US healthcare processes, compliance, and operational best practices. Develop training materials, SOPs, and e‑learning modules related to contract loading and claims flagging. Conduct workshops, webinars, and knowledge‑sharing sessions.

• C. Process Improvement & Advisory

  Identify gaps in current workflows and propose solutions to enhance accuracy and compliance. Collaborate with cross‑functional teams to implement process improvements. Prepare and present reports, dashboards, and recommendations to senior stakeholders.

• D. Compliance & Quality Assurance

  Ensure adherence to healthcare regulations and company policies in all consulting and training activities. Stay updated on industry regulations and emerging trends in US healthcare.

Education & Experience

Graduation or equivalent (required). 7+ years of experience in healthcare and claims adjudication. 2+ years of experience in training is preferred. 3+ years of experience in Prepay/Post‑pay Payment Integrity, Data Mining, or Contract Audit. Knowledge of healthcare reimbursement systems, payer‑provider contracts, and claims adjudication processes is a plus.

Skills & Competencies

Strong understanding of contract rate loading and healthcare payment processing systems, with the ability to interpret and apply complex provider agreements. Highly detail‑oriented with strong analytical and problem‑solving capabilities, especially in identifying payment discrepancies and root causes. Proficient in Microsoft Office Suite, particularly Excel (pivot tables, formulas, VLOOKUP), along with Word and Outlook. Hands‑on experience with healthcare claims platforms such as Facets, TriZetto, or similar systems used in US healthcare operations. Excellent verbal and written communication skills, enabling effective collaboration with internal teams and external stakeholders. Strong organizational and time‑management skills, with the ability to handle multiple priorities and meet tight deadlines in a dynamic environment.

Location

Bangalore, India