Senior Payment Integrity Lead: Data-Driven Claims

IEHP; Rancho Cucamonga (CA); On-site; USD 91,000 - 121,000; Full time

Benefits offered by this job

Competitive salary

On-site fitness center

Medical, Dental, Vision insurance

Life and disability insurance

Career development

Job summary

IEHP is seeking a Senior Payment Integrity Analyst in Rancho Cucamonga to lead a team of analysts and oversee payment integrity operations. The role focuses on QA, remediation planning, and driving cost containment.

Ideal candidates have 5+ years in payment integrity or related fields, strong data skills (SQL, analytics), and a Bachelor’s degree in a relevant field. Certification is preferred. Competitive benefits and on-site amenities are offered.

Qualifications

• Minimum of five (5) years in payment integrity, claims auditing, and/or medical coding.
• Strong data analysis/queries experience.
• Experience with contract and DOFR interpretation.
• Bachelor’s degree in business, health administration, or related field; four years’ extra experience allowed in lieu of degree.
• Certification in RHIA, RHIT, CCS, CPC, CIC or similar preferred.

Responsibilities

• Lead a team of Payment Integrity Analysts on daily operations and vendor programs.
• Quality assurance of junior analysts’ work and remediation planning.
• Lead reporting and tracking of vendor activity for daily/monthly management reports.
• Partner with leaders to drive health plan financial performance and regulatory compliance.

Skills

Billing regulations

Medical coding

Data analysis

SQL proficiency

Communication skills

Independent work

Education

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

Alternative with ≥4 years relevant work experience

RHIA/RHIT/CCS/CPC/CIC certification preferred

Job description

IEHP is seeking a Senior Payment Integrity Analyst in Rancho Cucamonga to lead a team of analysts and oversee payment integrity operations. The role focuses on QA, remediation planning, and driving cost containment.

Ideal candidates have 5+ years in payment integrity or related fields, strong data skills (SQL, analytics), and a Bachelor’s degree in a relevant field. Certification is preferred. Competitive benefits and on-site amenities are offered.