Remote Health Plan Payment Integrity Program Lead

Jobgether; United States; Remote; USD 69,000 - 135,000; Full time

Benefits offered by this job

Remote work flexibility

Competitive compensation

Cross-functional collaboration

Job summary

Jobgether is seeking a Program Manager, Health Plan Payment Integrity (Claims & Recovery) in the United States. This remote, full-time role leads payment integrity initiatives, oversees recovery programs, and works with claims, finance, compliance, and network teams to deliver compliant, data-driven solutions.

The ideal candidate has 5+ years in managed care analytics, Medicaid/Medicare experience, and strong data analysis skills.

Qualifications

• 5+ years as a business analyst in a managed care organization.
• 3+ years Medicaid/Medicare experience or equivalent.
• Experience managing operational projects from concept to execution.
• Strong knowledge of CPT, ICD, HCPCS, and revenue codes.
• Understanding of federal/state Medicaid payment regulations.
• Experience in payment integrity or related healthcare claims operations.
• Strong data analysis and querying ability.
• Excellent communication and cross-functional collaboration.

Responsibilities

• Lead health plan payment integrity initiatives and drive improvements.
• Manage SAIs and ensure targets are met.
• Oversee CMS/state regulatory pre/post-payment activities.
• Collaborate with claims, finance, compliance, and network teams.
• Translate complex challenges into actionable strategies.
• Prepare data summaries and visualizations for leadership.
• Develop business cases and reporting linking outcomes to financial targets.

Skills

Healthcare analytics

Stakeholder communication

Regulatory compliance

Data analysis

Project leadership

Tools

Excel

SQL

Data visualization

Job description

Jobgether is seeking a Program Manager, Health Plan Payment Integrity (Claims & Recovery) in the United States. This remote, full-time role leads payment integrity initiatives, oversees recovery programs, and works with claims, finance, compliance, and network teams to deliver compliant, data-driven solutions.

The ideal candidate has 5+ years in managed care analytics, Medicaid/Medicare experience, and strong data analysis skills.