About the Role

Traditional payment integrity solutions identify errors after claims have already been adjudicated, when denials, appeals, and rework are already underway. Availity Payment Accuracy operates earlier in the claims lifecycle by validating claims at submission—before they enter a health plan’s systems. By resolving issues upstream, we reduce avoidable denials, administrative burden, provider abrasion, and overall healthcare costs.

As an Operations Expert, you will serve as the operational bridge between clients and internal teams, partnering closely with Product, Engineering, and Operations to ensure successful implementation, execution, and ongoing optimization of Payment Accuracy solutions. You will translate customer needs into actionable technical requirements, coordinate cross-functional efforts, and drive operational excellence throughout the product lifecycle.

Sponsorship, in any form, is not available for this position.

Location: Remote, US

Key Responsibilities

• Serve as the primary operational liaison between clients and internal Product, Engineering, Clinical, and Operations teams.

• Meet with customers to understand business priorities, uncover root needs, and translate those needs into actionable technical and operational requirements.

• Coordinate cross-functional initiatives to deliver new edits, product enhancements, and customer-specific solutions.

• Partner with Product and Engineering to prioritize work, clarify requirements, and ensure solutions address meaningful customer and business problems.

• Manage customer communications, providing proactive updates on edit progress, issue resolution, and enhancement timelines.

• Support EDI file automation by analyzing mapping failures, troubleshooting issues, coordinating remediation efforts, and ensuring SLA compliance.

• Configure, maintain, and troubleshoot edit profiles, routing logic, and translation workflows.

• Collaborate with claims, eligibility, and business stakeholders to design and implement technical edit solutions.

• Prepare and maintain technical documentation, testing scenarios, implementation guides, and operational support procedures.

• Identify opportunities to standardize and scale operational processes and influence the development of reusable platform capabilities across multiple products.

• Monitor operational performance, identify trends, and recommend process improvements to enhance customer experience and operational efficiency.

Required Qualifications

• 4+ years of healthcare industry experience, preferably with claims processing, EDI transactions, or payment operations.

• 2+ years of Payment Integrity experience with a strong understanding of payment integrity products, workflows, and business processes.

• Experience partnering with Product, Engineering, Architecture, and Delivery teams in a cross-functional environment.

• Demonstrated ability to translate customer and business needs into technical solutions and delivered outcomes.

• Experience leading or supporting enterprise operational transformation initiatives.

• Knowledge of provider workflows, claims adjudication, payment operations, and healthcare business processes.

• Strong analytical, communication, and stakeholder management skills, with the ability to influence across technical and business teams.

Preferred Qualifications

• Experience with software development, systems implementation, or technical solution delivery.

• Experience working with healthcare EDI transactions (837, 835, 270/271, etc.).

• Familiarity with healthcare payer operations and payment integrity technologies.

• Experience managing complex implementations involving multiple cross-functional stakeholders

Availity culture and benefits:

• Availity is a certified “Great Place to Work”! Culture is important to us and there are many ways for you to make your mark here!

• We have several Diversity & Inclusion teams, a Young Professionals Group, a She Can Code IT group for women in tech, and various ways to engage with fellow Availity associates. 

• Availity is a culture of continuous learning. We have many resources and experts in our tech stack and in our industry that can help get you there too!

• Don’t feel like wearing business attire? Cool, you can wear jeans – we are a casual place.

• We offer a competitive salary, bonus structure, generous HSA company contribution, healthcare, vision, dental benefits and a 401k match program that you can take advantage of on day one! 

• We offer unlimited PTO for salaried associates + 9 paid holidays. Hourly associates start at 19 days of PTO and go up from there with all the same holiday benefits. 

• Interested in wellness? We allow our associates to reimburse up to $250/year for gym memberships, participation in racing events, weight management programs, etc.

• Interested in furthering your education? We offer education reimbursement!

• Availity offers Paid Parental Leave for both moms and dads, both birth parents and adoptive parents. 

• Want to work for an organization that gives back to the community? You’re at the right place! Availity partners with various organizations, both locally and nationally, to raise awareness, funds and morale as our staff members volunteer their time and funds to engage the organizations campaign.

Next steps:

After you apply, you will receive text/email messages thanking you for applying and then you will continue to receive more text/email messages alerting you as to where you are in the recruitment process. 

Interview process: 

• Recruiter Video Pre-Screen

• Video Interview with Hiring Manager

• Video Panel Interview

Video Camera Usage:

Availity fosters a collaborative and open culture where communication and engagement are central to our success.  As a remote first company, we are also camera-first and provide all associates with camera/video capability to simulate the office environment. If you are not able to use your camera for all virtual meetings, you should not apply for this role.

Having cameras on helps create a more connected, interactive, and productive environment, allowing teams to communicate more effectively and build stronger working relationships.  The usage of cameras also enhances security and protects sensitive company information. Video participation is required to ensure that only authorized personnel are present in meetings and to prevent unauthorized access, data breaches, preventing social engineering, or the sharing of confidential information with non-participants.