Remote WI: Payment Integrity Lead & Audit Oversight

Network Health; Menasha (WI); On-site; USD 80,000 - 120,000; Full time

Job summary

Network Health seeks a Supervisor of Payment Integrity to guide and oversee data collection, reporting, and analysis for claims and enrollment audits, fraud investigations, and corrective actions. The role emphasizes leadership, policy adherence, and cross‑functional coordination to sustain payment accuracy.

You will manage hiring, training, and performance reviews, partner with departments to improve audit algorithms, and develop dashboards tracking audit status and outcomes.

Qualifications

• Bachelor’s degree or equivalent years of experience required.
• 3+ years health care or health insurance experience.
• 2+ years in a quality assurance or auditing role.
• 1+ years in leadership or mentoring.

Responsibilities

• Lead personnel actions including interviewing, disciplinary actions, payroll, and compliance with policies.
• Oversee audits, ensure timely reviews and communicate findings and action steps.
• Manage fraud, waste and abuse investigations and coordinate with departments.
• Monitor payment accuracy and quality assurance audits; report results to leadership.
• Develop audit algorithms with other departments to improve accuracy.
• Provide team leadership through regular meetings and performance reviews.
• Hire, train, and manage team performance with HR collaboration.
• Prioritize review activities and ensure SLAs are met and reported to leadership.
• Drive productivity and continuous process improvements across the team.
• Develop and maintain a dashboards for audit progress and outcomes.

Skills

Leadership

Quality Assurance

Auditing

Team Management

Communication

Education

Bachelor’s degree or equivalent experience

Job description

Network Health seeks a Supervisor of Payment Integrity to guide and oversee data collection, reporting, and analysis for claims and enrollment audits, fraud investigations, and corrective actions. The role emphasizes leadership, policy adherence, and cross‑functional coordination to sustain payment accuracy.

You will manage hiring, training, and performance reviews, partner with departments to improve audit algorithms, and develop dashboards tracking audit status and outcomes.