Senior Lead Payment Integrity

SmartLight Analytics; Plano (TX); On-site; USD 130,000 - 170,000; Full time

Job summary

SmartLight Analytics is seeking a Senior Lead of Carrier Engagement to drive end‑to‑end carrier network performance and relationship management. This role oversees payment operations, quality assurance, and experience management, collaborating with IT to enhance tools and processes.

You will lead partnerships, ensure compliance, and deliver data‑informed improvements across internal and external reviews. The ideal candidate brings 5–10+ years in payment integrity or related fields, strong

Qualifications

• Bachelor’s degree in business, operations, or related field; advanced degree preferred.
• Strong analytical, problem‑solving, and process‑improvement skills.
• Payor/Carrier experience is required.
• 5–10+ years of experience in payment integrity operations, financial operations, or quality management.

Responsibilities

• Attend monthly Business Review meetings with clients providing detailed and analytical data insights as it relates to carrier engagement.
• Attend monthly Carrier meetings providing referral findings and leading data-driven discussion.
• Facilitate feedback loops to understand carrier needs and drive continuous improvement.
• Hands‑on delivery of the carrier experience vision, standards and service models.
• Lead initiatives that strengthen trust, transparency, and partnership with carriers.
• Identify performance gaps and lead cross‑functional improvement plans.
• Manage escalations and ensure timely resolution of carrier issues.
• Champion a consistent, high‑quality experience across all carrier and client touchpoints.
• Serve as an executive liaison for carrier and client relationships focusing on service, performance and partnership.
• Develop team capabilities in communication, analytics, relationship management, and problem‑solving

Skills

Relationship building

Analytical mindset

Communication skills

Problem solving

Process improvement

Education

Bachelor’s degree in business/operations or related field

Job description

The Senior Lead of Carrier Engagementis responsible forthe end‑to‑end performance, satisfaction, and operational excellence of the company’s carrier network. This role develops, manages, and strengthens strategic carrier relationships while ensuring accuracy, compliance, service quality, and a consistently positivecarrierexperience. Acting as the primary liaison between carriers and internal teams, the Senior Lead drives alignment, transparency, and continuous improvement across communication, operations, payment processes, andpartnership programs.

This position oversees key functions including payment operations, quality assurance, carrier engagement, and experience management. The Senior Lead initiates andmaintainssavings and performanceimprovement initiatives with carrier partners,identifyingopportunities for operational enhancements and friction reduction. The role also provides analytical insights and performance reporting during internal and external business reviews,representingthe organization in client and carrierfacing discussions.

Additionally, the Senior Lead collaborates closely with IT andcrossfunctionalteams to enhance tools, processes, and technologyimpactingcarriers and the carrier engagement team. By championing operational integrity, strengthening partnerships, and driving data‑informed improvements, this role ensures a seamless, reliable, and transparent end‑to‑end experience for carriers, partners, and internal stakeholders while supporting organizational growth.

Responsibilities

• Attendmonthly Business Review meetings with clients providing detailed and analytical data insights as it relates to carrier engagement.

• Attend monthly Carrier meetingsproviding referral findings and leading data-driven discussion

• Facilitate feedback loops to understand carrier needs and drive continuous improvement

• Hands‑on delivery of the carrier experience vision,standardsand service models

• Leadinitiatives that strengthen trust, transparency, and partnership with carriers

• Identifyperformance gaps and lead cross‑functional improvement plans

• Manageescalations and ensuretimelyresolution of carrier issues

• Champion aconsistent, high‑quality experience across all carrierand clienttouchpoints

• Serve as an executive liaison for carrier and client relationships focusing on service,performanceand partnership

• Develop team capabilities in communication, analytics, relationship management, and problem‑solving

Qualifications

• Bachelor’s degree inbusiness, operations, or related field; advanced degree preferred

• Payor/Carrier experience isrequired

• 5- 10+ years of experience in paymentintegrityoperations, financial operations, or quality management

• Experience managingthe payment integrity operations process, workflowpatternsandcomplex operational programs

• Experience managing external partners or vendors preferred

• Strong analytical, problem‑solving, and process‑improvement skills

Skills & Competencies

• Strong relationship‑building and communication skills

• Ability to navigate, understand and explain claims and billing data

• Some combination of coding/medical records or carrier payment integrity work

• Analytical mindset with the ability to interpretlargedatasetsand drive decisions

• Excellent organizational and project management abilities

• Ability to navigate complex issues with diplomacy and accountability

Success Indicators

• Carriers consistently meet or exceed performance expectations

• Strong, collaborative relationships with carriers and internal teams

• Reduced escalations and improved issue‑resolution timelines

• Clear, consistent communication and documentation across all carrier interactions

• Measurable improvements in carrier satisfaction and operational efficiency

Who isSmartLightAnalytics

SmartLightAnalytics was formed by a group of industry insiders who wanted to make a meaningful impact on the rising cost of healthcare. With this end in mind,SmartLightworks for self-funded employers to reduce wasteful spending in their healthcare plan through our proprietary data analysis. Our process works behind the scenes to save money without interrupting employee benefits or requiring employee behavior changes.