Carelon Payment Integrity Manager - Kansas
Core
Ensures accuracy of claims payment through managing processes for prevention, detection, and correction of billing, payment, and membership errors while overseeing fraud, waste, and abuse compliance.
Role type
Payment Integrity Manager
Builds
Robust processes for claims payment accuracy and fraud detection
Domain
Healthcare administration and compliance
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
Claims payment accuracy, Fraud detection, Waste and abuse prevention, Regulatory compliance, Process flow documentation, Project execution, Performance guarantee review, Cross-functional collaboration
Preferred skills
Fraud, Waste and Abuse experience, Payment integrity experience, Claims systems knowledge, GBD Facets familiarity
Responsibilities
Coordinate executive inquiries, Process Payment Integrity waivers, Prepare RFP responses, Document process flows, Review performance guarantees, Evaluate provider activities for fraud, Monitor compliance plans, Develop monthly reports, Create project plans, Analyze regulatory changes
Seniority
Mid-level individual contributor