Healthcare Payment Integrity Solutions Consultant

DOMA Technologies, LLC; Virginia Beach (VA); Hybrid; USD 120,000 - 150,000; Full time

Job summary

Commence is seeking a Healthcare Program Integrity Solutions Consultant to drive domain expertise across commercial payer initiatives, focusing on fraud, waste and abuse, SIU operations, and payment integrity. You will support sales, customer success, product and engineering teams.

The role requires translating complex payer workflows into technology use cases, contributing to demonstrations, RFP/RFI responses, and onboarding efforts, while traveling domestically as needed.

Qualifications

• Bachelor's degree in healthcare administration, public health, business, or related field.
• Minimum 5 years in healthcare fraud, waste and abuse, payment integrity, or SIU within commercial payers.
• Deep knowledge of payer payment integrity operations including pre-payment review and post-payment recovery.
• Ability to translate operational knowledge into practical technology use cases and client narratives.
• Strong written and verbal communication with healthcare stakeholders.
• Ability to travel within the United States monthly.

Responsibilities

• Serve as the primary internal and external expert on commercial payer payment integrity operations.
• Develop domain-focused documentation for Sales, Pre-Sales, and Customer Success teams.
• Partner with product and engineering to reflect payment integrity workflows in design.
• Stay current on fraud trends and regulatory changes affecting health plan integrity.
• Represent Commence's expertise at industry events to build credibility.
• Support onboarding and implementation to align the platform with client workflows.

Skills

Communication skills

Domain expertise

Travel readiness

Education

Bachelor's degree in healthcare administration, public health, business, or related field

Tools

Fraud detection platforms

Case management tools

Clinical review technologies

Job description

Commence is seeking a Healthcare Program Integrity Solutions Consultant to drive domain expertise across commercial payer initiatives, focusing on fraud, waste and abuse, SIU operations, and payment integrity. You will support sales, customer success, product and engineering teams.

The role requires translating complex payer workflows into technology use cases, contributing to demonstrations, RFP/RFI responses, and onboarding efforts, while traveling domestically as needed.