ZipRecruiter

Log In

1

Director Payment Integrity Jobs (NOW HIRING)

Bcbsa

Director, Payment Integrity

Chicago, IL

The Director, Payment Integrity serves as BCBSA's enterprise leader for advancing a System-wide payment integrity strategy that strengthens affordability across the Blue Cross Blue Shield System.

Judi Health

Director, Payment Integrity

Charlotte, NC · On-site

The Director, Payment Integrity will build and lead Judi Health's payment integrity program from inception, establishing the infrastructure, processes, and team that will ensure claims are paid ...

Bcbsri

Director Payment Integrity

Providence, RI · On-site +1

$116K - $187K/yr

Oversee and direct programs that create a strong Payment Integrity program by developing/enhancing exiting vendor relationships and seeking new vendor relationships in alignment with the corporate ...

Centene

Director, Payment Integrity - Edit Programs

$107K - $199K/yr

Monitor laws and regulations that may impact payment integrity policies and procedures and ... Direct and lead Prepay Compliance Managers in their efforts to reduce waste, abuse, and fraud

New

Socket.dev

Director Payment Operations - Michigan

Flint, MI · On-site

$140 - $190/hr

We are looking for a Director, Payment Operations, to join in leading the organization forward. MHP ... This role is accountable for the accuracy, timeliness, compliance, and financial integrity of ...

Cotiviti

Director Quality (Payment Integrity)

Overview The Director of Quality is responsible for ensuring quality delivery of the Payment Integrity Solution and driving excellence across multiple payment integrity products. This role will ...

Cotiviti

Director Quality (Payment Integrity)

Overview The Director of Quality is responsible for ensuring quality delivery of the Payment Integrity Solution and driving excellence across multiple payment integrity products. This role will ...

HealthPartners

Payment Integrity Manager

Bloomington, MN · On-site

$51.85 - $77.77/hr

The Payment Integrity Manager will lead the development, governance, and optimization of ... Directing medical coding review team with multi-disciplinary operational efficiency. * Lead medical ...

next page

Showing results 1-20

All JobsFinance and Insurance JobsAccounting JobsAccounting Professional JobsDirector Payment Integrity Jobs

Director Payment Integrity information

What does a director of payment integrity do?

A Director of Payment Integrity is responsible for overseeing programs and strategies that ensure accurate payments within a healthcare or insurance organization. This role focuses on identifying and preventing improper payments, such as overpayments or fraud, by analyzing claims data, implementing process improvements, and ensuring compliance with regulations. Directors of Payment Integrity work closely with other departments to optimize payment accuracy, reduce financial risk, and enhance overall operational efficiency. They may also lead teams, develop training, and report on key performance metrics related to payment integrity initiatives.

How does a director of payment integrity typically collaborate with cross-functional teams to ensure accurate claims processing?

A Director of Payment Integrity regularly works with teams such as claims, IT, compliance, and provider relations to develop and implement strategies that minimize payment errors and fraud. Collaboration often involves leading meetings to review audit findings, coordinating the integration of technology solutions, and ensuring all departments are aligned on regulatory requirements. This cross-team approach helps streamline workflows, enhances data accuracy, and supports continuous improvement initiatives to safeguard the organization's financial health.

What are the key skills and qualifications needed to thrive as a director of payment integrity, and why are they important?

To thrive as a Director of Payment Integrity, you need a strong background in healthcare claims management, analytics, and regulatory compliance, often supported by a bachelor's or master's degree in healthcare administration, business, or a related field. Expertise with claims processing systems, data analytics tools like SQL or SAS, and relevant certifications such as Certified Professional Coder (CPC) are commonly required. Exceptional leadership, strategic thinking, and communication skills help drive cross-functional initiatives and foster collaborative problem-solving. These competencies are crucial to effectively identify and mitigate payment inaccuracies, ensuring compliance and optimizing financial performance for healthcare organizations.

What is the difference between Director Payment Integrity vs Payment Integrity Analyst?

AspectDirector Payment IntegrityPayment Integrity Analyst
CredentialsBachelor's degree, often advanced certifications in healthcare or financeBachelor's degree, relevant certifications preferred
Work EnvironmentLeadership role overseeing teams and strategiesAnalytical role focused on data review and issue resolution
Employer & Industry UsageHealthcare payers, insurance companies, large healthcare organizationsHealthcare providers, insurance companies, claims processing units
Search & Comparison IntentUnderstanding managerial responsibilities and strategic oversightFocus on data analysis and claims review processes

The main difference between a Director Payment Integrity and a Payment Integrity Analyst lies in their level of responsibility and scope. The Director oversees teams, develops strategies, and manages overall payment integrity programs, while the Analyst focuses on data analysis, claims review, and issue resolution. Both roles require relevant healthcare or finance certifications, but the director's role is more strategic and leadership-oriented.

More about Director Payment Integrity jobs

What cities are hiring for Director Payment Integrity jobs?

Cities with the most Director Payment Integrity job openings:

What states have the most Director Payment Integrity jobs?

States with the most job openings for Director Payment Integrity jobs include:

What job categories do people searching Director Payment Integrity jobs look for?

The top searched job categories for Director Payment Integrity jobs are:

Director Payment Integrity jobs near you
Infographic showing various Director Payment Integrity job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 82% Full Time, 15% Part Time, and 2% Contract. Highlights an 93% Physical, 2% Hybrid, and 5% Remote job distribution.

Director, Payment Integrity

Bcbsa

Chicago, IL

Full-time

Medical, Dental, Vision, Retirement, PTO

Re-posted 16 days ago

Job description

The Director, Payment Integrity serves as BCBSA's enterprise leader for advancing a System-wide payment integrity strategy that strengthens affordability across the Blue Cross Blue Shield System. This role is responsible for scoping, planning, and driving strategic PI initiatives in close partnership with BCBSA business leaders for Commercial Markets, Government Markets, and FEP, as well as BCBS Plan PI and business leaders. The role brings deep subject matter expertise, executive presence, and a solutions-oriented mindset to ensure the Blues remain competitive across all lines of business in their payment integrity capabilities.

BlueCard Payment Integrity Program

  • Serve as the business owner for BCBSA's effort to integrate payment integrity into BlueCard claims processing a significant and complex initiative spanning strategy through operations.
  • Lead the scoping and design effort to define what PI within BlueCard needs to look like.
  • Drive the operationalization strategy, including Plan engagement and change management across the System.
  • Own the build-out and eventual ongoing management of BlueCard PI operations at BCBSA.

National Accounts Payment Integrity

  • Serve as the accountable leader for ensuring the Blue System meets the payment integrity needs of national accounts, with a focus on hosted PI requirements and performance.
  • Identify gaps in the current National Account space to develop future state roadmap.
  • Define and maintain PI capability requirements for BCBS Plans in support of hosted national account business.
  • Oversee PI reporting for national accounts and ensure Plans are meeting established requirements.
  • Serve as a thought partner and System navigator when new PI challenges emerge, helping to formulate the Blue System's response given its unique construct (e.g., developing the System's approach to audit vendor activity)

Government Markets - FEP Medicare Advantage Wrap

  • Serve as the PI subject matter expert advising Government Markets as it stands up the FEP Medicare Advantage wrap product and associated PI capabilities.
  • Advise on PI operational requirements, program design, and best practices as the product is developed.
  • Ensure appropriate PI controls and standards are embedded from the outset support government Markets leaders in building a sustainable PI framework for this new line of business FEP Payment Integrity.
  • Partner with FEP leadership as a PI subject matter expert, with a focus on performance monitoring and continuous improvement.
  • Advise on PI requirements and best practices for the FEP membership population
  • Establish monitoring of PI performance and drive results over time
  • Identify and recommend Plan specific along with National FEP improvement opportunities as the program matures.
  • Partner with contracted pharmacy vendor(s) in support of FEP Commercial and EGWP lines of business, ensuring appropriate reporting to OPM and CMS.
    Payment Integrity Leadership
  • Lead the Payment Integrity workgroup to align the Blue System around shared PI priorities and capabilities.
  • Facilitate strategic planning, information sharing, and consensus-building across Plans and BCBSA stakeholders.
  • Evaluate emerging market trends and translate them into actionable System-wide recommendations.
  • Partner with the Segment Positioning team on strategic issues and market trends to ensure PI priorities are reflected in broader Blue System strategy
    Represent BCBSA in industry forums and keep pace with the evolving PI landscape.

The posting range for this position is:

141,270.37 - 191,046.72


Qualifications:
Education

  • Required BS or equivalent experience; in Business Administration, Healthcare Administration, Finance or related field.; or equivalent experience
  • Preferred MS or MBA in Healthcare Administration, Public Health or Business Analytics

Experience

  • Required 12+ Years Progressive Experience in healthcare payment integrity and claims operations


Knowledge Skills and Abilities

  • Payment Integrity Expertise including deep knowledge of PI methodologies (prepay/post-pay edits, audits, fraud detection, COB, Subrogation, DRG Auditing, Overpayment Recoveries, Clinical Coding, Claims Analysis), claims adjudication systems, and controls across Commercial, Medicare Advantage, and FEP lines of business.
  • Demonstrated success leading complex, multi-stakeholder initiatives across distributed organizations
  • Experience managing programs with P&L impact of $100M+ annually.
  • Experience building operational capabilities from concept through execution
  • Experience with matrix organizational navigation and ability to influence without direct authority.
  • Background spanning commercial and government programs (Medicare Advantage, FEP).
  • Experience with vendor selection, contracting, and performance management for payment integrity services.
  • Strategic & Business Acumen with the ability to scope ambiguous enterprise initiatives, build business cases with ROI analysis, and translate operational complexity into executive strategy.
  • Strong data & analytics background with the ability to leverage data for program design and performance measurement. Understanding of AI/ML applications in payment integrity preferred.
  • Program Management skills with a track record leading multi-year transformation initiatives with strong change management capabilities and vendor oversight.
  • Exceptional executive communication skills equipped to present to senior leaders, facilitate strategic discussions, and serve as trusted advisor to business unit heads.
  • Possesses a solutions-orientated mindset with a bias toward action with ability to balance strategic vision and operational pragmatism
  • Prior Blue Cross Blue Shield System experience preferred

#LI-Hybrid

The posted salary range is the lowest to highest salary we, in good faith, believe we would pay for this role at the time of this posting. We may ultimately pay more or less than the hiring range and this hiring range may also be modified in the future. A candidate's position within the hiring range may be based on several factors including, but not limited to, specific competencies, relevant education, qualifications, certifications, relevant experience, skills, seniority, performance, shift, travel requirements, and business or organizational needs.This job is also eligible for annual bonus incentive pay.

We offer a comprehensive package of benefits including paid time off, 11 holidays, medical/dental/vision insurance, generous 401(k) matching, lifestyle spending account and many other benefits to eligible employees.

Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.

Apply