Referso Jobs

Business Consultant

HealthEdge · Posted Jun 29, 2026

Open

Remote, United States
Remote
Full-time
$90K–$120K per year

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Business Consultant

HealthEdge · Posted Jun 29, 2026

Open

Remote, United States
Remote
Full-time
$90K–$120K per year

Apply with Referso

VP, Payment Integrity

HealthEdge · Posted Jun 26, 2026

Open

Remote, United States
Remote
Full-time · Executive
$240K–$265K per year
10–15 years

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The VP will be accountable for business performance, innovation strategy, external market leadership, and delivery of measurable value across clients and product portfolios for Payment Integrity.

Compensation

The annual US base salary range for this position is $240,000 to $265,000.

Responsibilities

Own the end-to-end payment integrity business strategy, operating model, and execution roadmap across the HealthEdge ecosystem
Accountable for portfolio performance, business growth, and achievement of financial objectives associated with payment integrity solutions
Define and execute a multi-year vision and transformation roadmap for payment integrity capabilities across the HealthEdge platform
Drive innovation strategies leveraging AI, analytics, automation, and emerging healthcare technologies
Lead business case development and investment strategies for new capabilities, partnerships, and market opportunities

Requirements

Bachelor’s degree required
MBA
MHA
MPH
Nice to have: CMS guidelines

Skills

healthcare experience payment integrity claims operations

Vice President, Claims and Provider Operations

SCAN Health Insurance · Posted Sep 17, 2026

Open

Long Beach, California, United States
Full-time · Vp
$260K–$325K per year
10–15 years

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Leads the strategy, performance, and modernization of claims, configuration, provider data, payment integrity, and capitation operations to build a high-performing, compliant, and scalable operating model that improves accuracy, timeliness, affordability, provider experience, and member outcomes.

Compensation

Base Pay Range: $260,000-$325,000, Salary + Incentive Plan

Responsibilities

Leads a multi-disciplinary organization across claims intake, adjudication, configuration, provider data operations, payment integrity, capitation, and operational support
Owns end-to-end operational accuracy, timeliness, compliance, and control performance across claims and provider operations
Leads the evolution and transformation of claims and provider operations through workflow simplification, delivery model optimization, and automation
Partners closely with IT, EDI Operations, Finance, Network Management, Compliance, Clinical, Appeals and Grievances, and other business leaders to optimize claims system configuration and provider data integrity
Drives affordability through payment integrity and disciplined claims controls

Requirements

Bachelor's Degree
MBA
Nice to have: AI
Nice to have: automation
Nice to have: predictive analytics

Skills

claims processing

Advisory Manager, Payer Operations

UnitedHealth Group · Posted Nov 8, 2026

Open

Minneapolis, Minnesota, United States +2 more
Hybrid
Full-time · Manager

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Lead healthcare payer consulting engagements focused on payment integrity and payer operations, managing teams and delivering client-ready recommendations.

Locations (3)

Minneapolis, Minnesota, United States
Washington, D.C., District of Columbia, United States
United States

Responsibilities

Lead teams and manage work through direct and indirect reports
Deliver projects on time
Translate analysis and stakeholder feedback into clear, client-ready recommendations
Translate analysis and stakeholder feedback into clear, client-ready recommendations

Skills

payment integrity payer operations

Sr. Manager, Healthcare Claims & Revenue Cycle Operations

Intellivo · Posted Nov 5, 2026

Open

Saint Louis, Missouri, United States
On-site
Full-time · Manager
$120K–$130K per year
7+ years

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Lead a 40+ person healthcare claims operation responsible for managing approximately $1 billion in recovery opportunities.

Compensation

Compensation: $120-130K + bonus

Responsibilities

Lead a High-Volume Healthcare Operation
Own performance across case progression, quality, productivity, timeliness, and financial outcomes
Establish clear expectations and build strong accountability for results
Ensure high-value and high-risk recovery opportunities receive appropriate attention, escalation, and financial stewardship
Drive Claims Recovery & Revenue Cycle Outcomes

Requirements

Bachelor’s degree preferred

Skills

healthcare claims Revenue Cycle Management payment integrity insurance operations claims recovery subrogation data analysis

Payment Integrity Lead - Strategy & Audit Optimization

Humana · Posted Nov 5, 2026

Open

Remote, United States
Remote
Full-time
$95K–$131K per year
8+ years

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Lead strategic Payment Integrity initiatives, identify and develop audit concepts, and drive operationalization across Humana's payment integrity functions.

Compensation

$94,900 - $130,500 per year

Responsibilities

Proactively identify net-new Payment Integrity and Data Mining opportunities
Monitor Medicare, Medicaid, and Commercial reimbursement trends
Research potential payment leakage and develop hypotheses for new audit concepts
Translate opportunities into audit concepts and testable business hypotheses
Partner with analytical, clinical, coding, policy, technology, and operational teams to test and validate new concepts

Requirements

Nice to have: Prepay and Postpay Payment Integrity strategies
Nice to have: Medicare and Medicaid reimbursement methodologies
Nice to have: CMS reimbursement methodologies
Nice to have: coding guidance
Nice to have: healthcare payment policies

Skills

healthcare claims payment integrity data mining audit

Business Change Director - Carelon Payment Integrity

Elevance Health · Posted Nov 5, 2026

Open

Indianapolis, Indiana, United States
Hybrid
Manager
10+ years

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Lead change and project initiatives to support business unit and enterprise goals within Carelon Payment Integrity.

Responsibilities

Identify and implement projects, programs and plans that support business unit and enterprise goals
Specialize in organization effectiveness areas such as planning, project portfolio, or culture/change
Identify potential issues, project change, and scope data
Lead efforts to identify best practices
Identify impacted parties, business partners, and resources required

Requirements

Bachelor's degree in a related field
Nice to have: Master's degree
Nice to have: Six Sigma Black Belt
Nice to have: 3-5 years experience in Payment Integrity
Nice to have: experience in payment integrity: data mining, recoveries, cost of care, or financial project management

Skills

change management project management Six Sigma payment integrity data mining

Sr Project Manager – Strategic Implementations QNXT

CVS Health · Posted Nov 5, 2026

Open

Remote, United States
Remote
Full-time · Senior
$83K–$183K per year
7+ years

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Senior Project Manager overseeing technical deployments on the QNXT platform within CVS Health’s Payment Integrity products.

Compensation

$82,940.00 - $182,549.00

Responsibilities

Plans, monitors and manages internal projects from initiation through completion
Secures required resources and uses formal processes and tools to manage resources, budgets, risks and changes
Manages projects to ensure on-time completion according to specifications and within budgeted costs
Adapts project management methodologies and best practices to meet the unique needs of each project
Advises project teams and stakeholders on project management principles, practices, and approaches

Requirements

Bachelor's degree
Nice to have: experience on a technical project or alignment with the QNXT Aetna commercial platform
Nice to have: experience in deploying technical implementations
Nice to have: specialized training or 10+ years of relevant professional qualification

Skills

project management payment integrity technical implementations

SIU Investigator - Remote

Martin’s Point Health Care · Posted Nov 4, 2026

Open

Remote, United States
Remote
Full-time · Senior
$76K–$93K per year
5+ years

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The SIU Investigator looks into suspected fraud, waste and abuse (FWA) by providers, suppliers, members, and other entities. The work covers both of Martin’s Point’s health plans: Generations Advantage and the US Family Health Plan (TRICARE).

Compensation

Pay Range: $75,584.55 - $93,369.15

Responsibilities

Investigates suspected FWA from start to finish.
Develops a plan that defines the allegation, scope and estimated financial exposure.
Analyzes claims data to identify billing patterns that stand out from peers, to estimate overpayment exposure, and to support statistically valid sampling and extrapolation.
Reviews medical records and supporting documentation against CMS and TRICARE requirements, Martin’s Point payment policies, CPT, HCPCS, and ICD-10-CM coding guidelines.
Coordinates clinical and coding review as needed with other internal departments.

Requirements

Bachelor’s degree in criminal justice, health care administration, accounting, or other related field
Nice to have: TRICARE
Nice to have: government program experience
Nice to have: AHFI
Nice to have: CFE

Skills

health care fraud investigation SIU

Claims Payment Integrity Specialist, Health Plan

Sanford Health · Posted Nov 4, 2026

Open

Remote, United States
Remote
Full-time · Associate
$22–$35 per hour
2+ years

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Responsible for identifying, preventing, and recovering improper claim payments across all lines of business, ensuring claims are paid accurately and compliantly.

Compensation

Starting Rate: $21.50 - $34.50

Responsibilities

Conducts pre or post payment claim reviews to identify overpayments, underpayments, duplicate payments, coding errors, and contractual discrepancies.
Analyze claims using data analytics, reporting tools, and audit methodologies to detect trends, anomalies, and potential payment risks.
Leads implementation of new initiatives to address incorrect payment trends or new claim editing solutions.
Validate claims compliance with CMS, state Medicaid agencies, ACA, ERISA, and applicable regulatory requirements.
Applies correct interpretation of benefits, provider contracts, fee schedules, reimbursement methodologies, and medical policies.

Requirements

Associate's degree in Healthcare Administration, Business, Finance or a related field
Bachelor’s degree
Nice to have: claims data analytics
Nice to have: recovery vendor management
Nice to have: CMS knowledge

Skills

claims payment integrity

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