Senior Lead Payment Integrity

The Senior Lead of Carrier Engagement is responsible for the end‑to‑end performance, satisfaction, and operational excellence of the company’s carrier network. This role develops, manages, and strengthens strategic carrier relationships while ensuring accuracy, compliance, service quality, and a consistently positive carrier experience. Acting as the primary liaison between carriers and internal teams, the Senior Lead drives alignment, transparency, and continuous improvement across communication, operations, payment processes, and partnership programs.

This position oversees key functions including payment operations, quality assurance, carrier engagement, and experience management. The Senior Lead initiates and maintains savings and performance improvement initiatives with carrier partners, identifying opportunities for operational enhancements and friction reduction. The role also provides analytical insights and performance reporting during internal and external business reviews, representing the organization in client and carrier facing discussions.

Additionally, the Senior Lead collaborates closely with IT and cross functional teams to enhance tools, processes, and technology impacting carriers and the carrier engagement team. By championing operational integrity, strengthening partnerships, and driving data‑informed improvements, this role ensures a seamless, reliable, and transparent end‑to‑end experience for carriers, partners, and internal stakeholders while supporting organizational growth.

Responsibilities

• Attend monthly Business Review meetings with clients providing detailed and analytical data insights as it relates to carrier engagement.

• Attend monthly Carrier meetings providing referral findings and leading data-driven discussion

• Facilitate feedback loops to understand carrier needs and drive continuous improvement

• Hands-on delivery of the carrier experience vision, standards and service models

• Lead initiatives that strengthen trust, transparency, and partnership with carriers

• Identify performance gaps and lead cross‑functional improvement plans

• Manage escalations and ensure timely resolution of carrier issues

• Champion a consistent, high‑quality experience across all carrier and client touchpoints

• Serve as an executive liaison for carrier and client relationships focusing on service, performance and partnership

• Develop team capabilities in communication, analytics, relationship management, and problem-solving

Qualifications

• Bachelor’s degree in business, operations, or related field; advanced degree preferred

• Payor/Carrier experience is required

• 5 - 10+ years of experience in payment integrity operations, financial operations, or quality management

• Experience managing the payment integrity operations process, workflow patterns and complex operational programs

• Experience managing external partners or vendors preferred

• Strong analytical, problem‑solving, and process‑improvement skills

Skills & Competencies

• Strong relationship‑building and communication skills

• Ability to navigate, understand and explain claims and billing data

• Some combination of coding/medical records or carrier payment integrity work

• Analytical mindset with the ability to interpret large data sets and drive decisions

• Excellent organizational and project management abilities

• Ability to navigate complex issues with diplomacy and accountability

Success Indicators

• Carriers consistently meet or exceed performance expectations

• Strong, collaborative relationships with carriers and internal teams

• Reduced escalations and improved issue‑resolution timelines

• Clear, consistent communication and documentation across all carrier interactions

• Measurable improvements in carrier satisfaction and operational efficiency

Who is SmartLight Analytics

SmartLight Analytics was formed by a group of industry insiders who wanted to make a meaningful impact on the rising cost of healthcare. With this end in mind, SmartLight works for self-funded employers to reduce wasteful spending in their healthcare plan through our proprietary data analysis. Our process works behind the scenes to save money without interrupting employee benefits or requiring employee behavior changes.