The Payment Integrity Lead drives payment accuracy, operational efficiency, and long-term value through analytics and strategic program execution. This role leads high-priority transformation efforts, pilots and operationalizes new capabilities, and partners across the enterprise to ensure Payment Integrity concepts and processes are compliant, effective, and aligned to business objectives. The Lead uses data-driven insights to identify improvement opportunities, optimize financial outcomes, prevent waste, and support scalable upstream solutions.
The Payment Integrity Lead contributes to overall operational effectiveness and cost optimization by improving the accuracy of claims payment, strengthening Payment Integrity processes, and advancing initiatives that reduce waste and improve financial outcomes. This individual leads high-priority projects and transformation efforts designed to pilot, evaluate, and operationalize new capabilities across Payment Integrity programs.
The Lead is responsible for driving payment accuracy and efficiency through analytics, governance, and strategic program execution. This includes evaluating Payment Integrity concepts, identifying process improvement opportunities, and ensuring concepts and processes are maintained in alignment with Payment Integrity standards, business objectives, operational requirements, and applicable compliance expectations.
This role partners closely with cross-functional teams to create clear alignment around business drivers, define actionable next steps, and sustain long-term value. The Payment Integrity Lead delivers actionable insights, supports program integrity, advances upstream solutions, and helps scale high-impact initiatives that improve operational performance and optimize financial outcomes.
Use your skills to make an impact Required Qualifications- Minimum 8 years of work experience in healthcare, claims operations, payment integrity, provider reimbursement, managed care, claims payment accuracy, and/or related operational areas.
- Minimum 2 years demonstrated experience leading complex initiatives, high-priority projects, or cross-functional programs from planning through execution.
- Strong analytical and problem-solving skills, including the ability to interpret data, identify trends, assess root cause, and translate findings into actionable recommendations.
- Experience evaluating operational processes, identifying improvement opportunities, and supporting implementation of process enhancements or new capabilities.
- Ability to exercise independent judgment and make decisions on complex issues with limited oversight.
- Strong communication skills, including the ability to present findings, recommendations, risks, and progress updates to leaders, business partners, and cross-functional stakeholders.
- Comprehensive knowledge of Microsoft Office Programs Word, PowerPoint, and Excel
Work-At-Home Requirements- At minimum, a download speed of 25 mbps and an upload speed of 10 mbps is recommended; wireless, wired cable or DSL connection is suggested
- Satellite, cellular and microwave connection can be used only if approved by leadership
- Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
- Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
- Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
Preferred Qualifications- Undergraduate degree
- Experience leading people and/or processes
- Experience in Financial Recovery
- Experience in a fast paced, metric driven operational setting
- Experience leading projects focused on innovation, technology enablement, automation, process transformation, or new capability development.
- Experience piloting, evaluating, or operationalizing new tools, systems, or technology-driven solutions.
- Experience using the following systems: CAS, MTV, CISpro and CIS
- Knowledge of Microsoft Office Programs Access and Project
- Project Management Professional (PMP) Certification
- Bilingual in Spanish and English
Additional Information- As part of our hiring process for this opportunity, we may contact you via text message and email to gather more information using a software platform called HireVue. HireVue Text, Scheduling, and Video technologies allow you to interact with us at the time and location most convenient for you.
- If you are selected to move forward from your application prescreen, you may receive correspondence inviting you to participate in a pre-recorded Voice, Text Messaging and/or Video interview. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.
Work at Home Requirements: To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
Scheduled Weekly Hours40
Pay RangeThe compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$94,900 - $130,500 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of BenefitsHumana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
