Senior Payment Integrity and Carrier Relations Analyst

4C Health Solutions, Inc.; Wilmington (DE); On-site; USD 110,000 - 150,000; Full time

Job summary

4C Digital Health is seeking a Senior Payment Integrity Analyst in Wilmington, DE to own the operational relationship with an assigned carrier account. You will identify overpayments, defend findings, and convert them into recovered dollars for clients.

This hands-on role blends data mining and pattern detection with credible, organized negotiation, leading carrier analyst sessions and surfacing new recovery opportunities.

Qualifications

• 7+ years in payment integrity, claims audit, overpayment recovery, or healthcare claims operations.
• Experience identifying overpayments and payment errors in medical claims data.
• Strong data-mining and analytical skills — comfortable with large claims datasets in Excel.
• Experience preparing and defending audit findings, disputes, appeals, or rebuttals with carriers, payers, or providers.
• Confident, organized communicator able to lead working sessions with carrier analyst teams.
• Ability to manage findings to resolution and report on dollars identified and recovered.

Responsibilities

• Serve as the operational lead and primary point of contact for an assigned carrier account — managing the day-to-day relationship, cadence, and follow-through.
• Review paid claims to identify potential overpayments, billing and coding discrepancies, and payment errors.
• Evaluate carrier responses and supporting documentation to determine whether original determinations are adequately substantiated; prepare and present clear, evidence-based rebuttals where they are not.
• Lead recurring working sessions with carrier analyst teams to review findings, resolve disputes, and move items to closure.
• Mine claims and payment data to surface new overpayment opportunities and expand the recovery pipeline.
• Track findings, rebuttals, and recoveries through resolution; report dollars identified and dollars recovered to leadership.
• Partner with clinical and coding reviewers so data-identified and clinically-identified findings reinforce one another rather than overlap.
• Document repeatable approaches and maintain account runbooks so coverage is never single-threaded.
• Surface recurring patterns — error types, documentation gaps, carrier behaviors — as opportunities to grow recoveries.

Skills

Data mining

Analytical skills

Excel (pivot tables & lookups)

Claims data analysis

Carrier relations & negotiations

Communication in working sessions

Job description

4C Digital Health is seeking a Senior Payment Integrity Analyst in Wilmington, DE to own the operational relationship with an assigned carrier account. You will identify overpayments, defend findings, and convert them into recovered dollars for clients.

This hands-on role blends data mining and pattern detection with credible, organized negotiation, leading carrier analyst sessions and surfacing new recovery opportunities.