council-capital - Payment Integrity Specialist
Requirements
• 2+ years of experience at a payer or a payment integrity / audit vendor. • Hands-on experience with claims processing and payment integrity auditing. • Exposure across multiple lines of business (commercial, FEP, Medicaid, Medicare); breadth is preferred over depth in a single line. • Strong analytical instincts: you find the significant problem in the data and work it to root cause. • Comfort with Excel and general software; you learn new claims systems quickly (system-specific training is provided per client). • A track record of hitting metric-driven, time-bound goals and staying composed under a monthly target. • High integrity and sound judgment; you make the call on findings and stand behind them. • Self-direction and ownership; you do not need to be managed through your queue. • Authorized to work in the U.S. and U.S.-based (this role handles PHI and cannot be performed offshore). • Prior payment integrity auditing specifically (vs. general claims auditing). • Experience generating audit concepts / recovery ideas • Council Capital and our portfolio companies are committed to building high-performing teams by hiring the best talent—period. • We believe in putting the right people in the right seats, regardless of background, and we’re always looking for individuals who bring fresh thinking, grit, and a drive to make a difference. • Thank you for considering a role with one of our companies. We’re excited to learn more about you.
Responsibilities
• Audit payer claims across multiple lines of business (commercial, FEP, Medicaid, Medicare) to identify improper payments and recovery opportunities. • Analyze claims data in depth to determine root causes of improper payments and build defensible audit findings. • Meet or exceed a monthly dollars-identified goal once assigned to a client (goal is set per client and audit type; expect a ramp during onboarding). • Maintain a high quality standard on all identified dollars, minimizing false positives so findings hold up under client review. • Generate new audit concepts and recovery ideas from patterns you see in the data (target of at least one new concept per month). • Support key stakeholders with on-time client deliverables, including audit results and documentation. • Apply payment integrity and claims-processing knowledge across different payers and claim systems as engagements shift. • Contribute to the team's shared knowledge (trends, methods, and audit playbooks) as our capabilities grow.
Benefits
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