Position Overview
The Senior Lead of Payment Integrity 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.