Payment Integrity Letter Implementation Professional Jobs

Become a part of our caring community Join our Payment Integrity Letters team at Humana where you will help draft and implement outbound communication templates for the Payment Integrity Operations teams as a Payment Integrity Professional 2. You will help ensure compliance with state contractual requirements and Humana brand standards in drafting communication templates and working with the approvers and developers. You will report to the Associate Director, Business Systems Analysis. Main responsibilities: Collaborate with business partners to draft new communications Review existing communications on an annual basis to ensure compliance with all state requirements and Humana brand standards Ensure intake requests are completing all required steps in a timely manner and escalate off track tasks as needed Work with the EMME development team to ensure communication requirements are documented clearly and implemented correctly Validate communications in QA and Production environments on a regular basis to identify gaps Use your skills to make an impact Required Qualifications 2+ years' experience tracking process deliverables Experience editing documents with Microsoft Office Programs Word, PowerPoint, and Excel Experience handling multiple priorities Experience with com

AI Engineer - Enterprise Search Overview We are looking for an experienced Enterprise Search Lead to build and optimize our multi-tenant enterprise search solution. This role focuses on creating scalable systems that integrate seamlessly with customer environments, leveraging cutting-edge AI and ML technologies. You will design and manage the enterprise knowledge graph, implement personalized search experiences, and drive AI- powered innovations to enhance search relevance and ITSM workflows. What You Will Do: Build and structure our enterprise knowledge graph to organize content, people, and activity into meaningful relationships for better search relevance. Develop and refine personalized ranking models that adapt to user behavior and improve search results over time. Design ways to adapt AI language models to each customerʼs data for enhanced accuracy and context. Explore innovative methods to combine LLMs with search engines for answering complex queries Write clean, robust, and maintainable code that integrates smoothly with multi-tenant systems. Collaborate with cross-functional teams to align search capabilities with ITSM workflows. Mentor junior engineers or learn from experienced ones to grow as a technical leader. What You Should Have 3-5 years of experience working on enterprise search products with AI/ML integration. Expertise in multi-tenant systems and securely integrating with external customer systems. Hands-on experience with tools like Elasticsearch, Solr, or similar search platforms. Strong coding skills in Python, Java, or equivalent languages. A passion for solving complex problems with AI and delivering intuitive user experiences. Important notice for candidates: Job scams are on the rise. Please keep these guidelines in mind when applying for any open roles at Atomicwork. Only apply through official Atomicwork channels. We do not use third-party agencies or individuals who ask for payments in exchange for interviews or offer letter

Lead Director, Business Consulting/Payment Integrity — CT - Hartford. Apply via Workday.

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Job Profile Summary Leads automation and AI transformation strategy across the Payment Integrity, Revenue Integrity, and Grievances and Appeals COEs. Builds and manages a team to ideate, prioritize, and oversee delivery of automation and agentic AI initiatives that improve claims accuracy, recovery, and appeals outcomes. Partners with COE and business leadership to align automation roadmaps to enterprise priorities, governance standards, and measurable business impact. Job Description A Brief Overview Leads a team to drive automation and AI-enabled transformation across Payment Integrity, Revenue Integrity, and Grievances and Appeals. Sets strategic direction for how automation and intelligent workflow opportunities are identified and scaled across these COEs, and ensures successful, on-time delivery through strong program oversight. Balances delivery accountability with team development, ensuring the group operates as a cohesive practice rather than three disconnected initiatives. What you will do Leads and develops a team, setting priorities, allocating capacity across COEs, and holding the team accountable to delivery and quality standards. Sets the automation transformation strategy for Payment Integrity, Revenue Integrity, and Grievances and Appeals in partnership with COE leadership. <

Opportunity Overview: We are seeking a versatile and highly skilled Lead Claims Auditor to join our dynamic Payment Integrity team. This critical role involves conducting comprehensive professional and facility coding reviews—encompassing both outpatient/professional and inpatient claims—to ensure the accuracy of code assignment, DRG/reimbursement, and to maximize overpayment identification. If you possess a CPC and/or CCS credential, expert knowledge of CPT, HCPCS, and ICD-10-CM/PCS coding guidelines, and a passion for deep analytical auditing, you will be instrumental in supporting our commitment to accurate reimbursement solutions. This opportunity requires a self-motivated individual who thrives on precision, compliance, and continuous learning in a high-growth environment What you’ll do: Conduct comprehensive coding reviews to ensure accuracy in code assignment and reimbursement. Conduct comprehensive outpatient and professional coding reviews to ensure accuracy in code assignment and reimbursement. Apply expert knowledge of coding guidelines and utilize industry-leading tools to maximize overpayment identifications. Conduct ambulatory surgery center, emergency room, observation and infusion coding reviews. Apply expert knowledge of coding guidelines and utilize industry-leading tools to maximize overpayment identifications. Craft clear, concise, and well-supported audit findings, backed by AHA Coding Clinic Guidelines and ICD-10-CM/PCS regulations. Utilize advanced DRG encoder tools (such as 3M, Webstrat) to drive efficiency and accuracy in audits. Meet or exceed company quality and productivity standards, including strong uphold rates for appeals. Stay ahead of industry trends, coding updates, and compliance regulations to maintain expert-level knowledge. Adhere to HIPAA and company policies and procedures to ensure data security and regulatory compliance. Maintain and apply superior knowledge of changes and updates to coding guidelines, reimbursement trends,

Opportunity Overview: We are seeking a versatile and highly skilled Claims Auditor to join our dynamic Payment Integrity team. This critical role involves conducting comprehensive professional and facility coding reviews—encompassing both outpatient/professional and inpatient claims—to ensure the accuracy of code assignment, DRG/reimbursement, and to maximize overpayment identification. If you possess a CPC and/or CCS credential, expert knowledge of CPT, HCPCS, and ICD-10-CM/PCS coding guidelines, and a passion for deep analytical auditing, you will be instrumental in supporting our commitment to accurate reimbursement solutions. This opportunity requires a self-motivated individual who thrives on precision, compliance, and continuous learning in a high-growth environment What you’ll do: Conduct comprehensive coding reviews to ensure accuracy in code assignment and reimbursement. Conduct comprehensive outpatient and professional coding reviews to ensure accuracy in code assignment and reimbursement. Apply expert knowledge of coding guidelines and utilize industry-leading tools to maximize overpayment identifications. Conduct ambulatory surgery center, emergency room, observation and infusion coding reviews. Apply expert knowledge of coding guidelines and utilize industry-leading tools to maximize overpayment identifications. Craft clear, concise, and well-supported audit findings, backed by AHA Coding Clinic Guidelines and ICD-10-CM/PCS regulations. Utilize advanced DRG encoder tools (such as 3M, Webstrat) to drive efficiency and accuracy in audits. Meet or exceed company quality and productivity standards, including strong uphold rates for appeals. Stay ahead of industry trends, coding updates, and compliance regulations to maintain expert-level knowledge. Adhere to HIPAA and company policies and procedures to ensure data security and regulatory compliance. Maintain and apply superior knowledge of changes and updates to coding guidelines, reimbursement trends, and

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary The Lead, Senior Decision Scientist serves as a strategic analytics and ideation leader supporting Payment Integrity Affordability initiatives with a primary focus on Fraud, Waste & Error (FWE) and Special Investigations Unit (SIU) programs. This role provides leadership and guidance to a team of Decision Scientists while driving the development, evaluation, and implementation of innovative opportunities that improve affordability outcomes and strengthen Payment Integrity capabilities. The Lead Decision Scientist is responsible for establishing analytical frameworks, managing ideation pipelines, defining success metrics, and identifying cross-functional opportunities that create enterprise value across Payment Integrity programs. Required Qualifications 7&#43; years of experience in healthcare analytics, Payment Integrity, Fraud, Waste & Error (FWE), Special Investigations, or related healthcare operations. 5&#43; years of experience leading analytical projects or providing technical leadership within a healthcare environment. Demonstrated experience working with healthcare claims platforms including ACAS, QNXT, HRP, or comparable systems. Experience using SAS, SQL, Python, R, or other analytical and statistical programming languages. Experience performing advanced data analysis, opportunity identification, trend analy

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary The Waste & Error Certified Coding Manager is responsible for leading the Certified Coding Analyst and W&E Team Lead roles that conduct medical claim reviews and coding audits to identify billing errors, waste, abuse, fraud, and payment integrity opportunities. The Manager provides direct people leadership, establishes operational priorities, ensures consistent application of coding and billing requirements, and is accountable for team productivity, quality, service levels, compliance, and employee development. This role partners closely with the W&E team lead, who provides day-to-day technical guidance and subject matter support to the coding team. The Manager retains accountability for staffing, performance management, workload oversight, escalations, audit readiness, process improvement, and delivery of business outcomes. The position also represents the team in discussions with senior leadership, Medical Directors, Legal, Compliance, Analytics, Operations, and other Payment Integrity partners. Primary Responsibilities People Leadership & Team Development Lead, coach, and develop a team of Certified Coding Analysts and Senior Certified Coding Analysts. Establish clear role expectations, performance goals, productivity standards, quality requirements, and accountability measures. Conduct regular perfor

Every day, tens of millions of people come to Roblox to explore, create, play, learn, and connect with friends in 3D immersive digital experiences– all created by our global community of developers and creators. At Roblox, we’re building the tools and platform that empower our community to bring any experience that they can imagine to life. Our vision is to reimagine the way people come together, from anywhere in the world, and on any device. We’re on a mission to connect a billion people with optimism and civility, and looking for amazing talent to help us get there. A career at Roblox means you’ll be working to shape the future of human interaction, solving unique technical challenges at scale, and helping to create safer, more civil shared experiences for everyone. We are hiring a Senior Product Policy Manager with expertise in creator economy platforms and payment fraud to join our growing Monetization Policy function. You will help us design policies, enforcement guidelines incorporated into financial integrity products, services, and technologies that support our global community of monetizing creators. As a part of the Product Policy team, you will have a global impact on our payment integrity and fraud mitigation strategy. You will collaborate internally with our product, engineering, business, legal, public policy, marketing, finance, and operations teams to help drive the business forward on a foundation of safety & civility. You will report to Roblox’s Platform Policy lead and sit within our larger Safety Group at Roblox. This role is based in San Mateo, CA and you are expected to be in office Tue through Thu. You have: 4+ years of experience with online anti-fraud, trust & safety, or product policy space, especially for digital payment and/or creator economy platforms Subject matter expertise in digital payments, virtual economies, and/or creator monetization platforms. Strong written and verbal communication skills; Able to distill c

At Lyft, our purpose is to serve and connect. We aim to achieve this by cultivating a work environment where all team members belong and have the opportunity to thrive. Our team is dedicated to creating a seamless and secure experience for our riders and drivers, ensuring their identity and data are protected at all times. As a Senior Product Designer, you'll lead the design of solutions that help drivers understand their earnings and get paid securely while protecting our communities from fraud. You will work closely with cross-functional teams, including product managers, designers, engineers, and data scientists, to create intuitive and effective designs on driver payments and complex security challenges. You’ll advocate for a customer-centric approach and thrive in a dynamic, fast-paced environment. From initial ideation through to launch, you'll support projects with interaction, visual, and product thinking skills, helping to define and deliver impactful experiences for our Payment, Identity and Integrity teams. The Opportunity Design features that help drivers understand their earnings, access their pay, and resolve payment issues efficiently Lead end-to-end design for driver earnings and identity verification experiences, from research and ideation through execution Play a critical role in designing solutions that protect our users and enhance their trust in our platform Collaborate with cross-functional partners to design intuitive and effective designs that address unique rideshare driver, identity and fraud challenges Responsibilities: Problem solve, think big, and explore divergent concepts/ideas while understanding how to converge and build iteratively towards your vision. Influence the shape of the product with research and data while executing design work using high quality wireframes, mockups, user journeys, and cross-platform interactive prototypes. Advocate for design by sharing your work and presenting cross-functionally, while being able to

End to end responsible for: • financial governance and legal risk management for the SBU by ensuring budget discipline, cash visibility and compliant controls. • payment governance and SAP/WBS/CTC integrity so spend aligns to approved baselines and audit expectations. • contract legal review, notice management and dispute support with commercial teams to protect Adani’s position. • financial risk monitoring across funding, working capital, claims exposure and statutory compliance obligations. • Ensures transparent MIS, audit-ready records and SLA-driven closures across stakeholders. Source: Adani Group | Job ID: 56844

Our Purpose Mastercard powers economies and empowers people in 200&#43; countries and territories worldwide. Together with our customers, we’re helping build a sustainable economy where everyone can prosper. We support a wide range of digital payments choices, making transactions secure, simple, smart and accessible. Our technology and innovation, partnerships and networks combine to deliver a unique set of products and services that help people, businesses and governments realize their greatest potential. Title and Summary Analyst, Franchise Services Job Title: Analyst- Franchise Services (Payment Processing Domain) Overview: The GBSC (Global Business Solutions Center) is the shared services organization for Mastercard that provides services to all regions and all business units spanning 50 countries. Consistent with the One LFI model, GBSC is partnering with the Law and Franchise Integrity team to build a Franchise shared services function. An analyst on the Franchise Services team within the GBSC will be responsible for assisting with Franchise initiatives ranging from, but not limited to, supporting Mastercard customers in areas such as compliance or customer onboarding to assisting with process efficiency and reporting projects. Are you comfortable with a changing and fast paced environment? Do you have experience with B2B customers? Are you committed to customer service? Are you agile; do you love challenges and consider the business first? Are you detail oriented? Role • Support B2B customers in navigating payment industry compliance programs and various activities related to on-boarding customers, registration, card design, variance requests and responding to ad-hoc customer requests. • Ensure customer experience and data quality requirements in accordance to customer governance requirements and Master

Who we are About Stripe Stripe is a financial infrastructure platform for businesses. Millions of companies from the world's largest enterprises to the most ambitious startups use Stripe to accept payments, grow their revenue, and accelerate new business opportunities. Our mission is to increase the GDP of the internet, and we have a staggering amount of work ahead. That means you have an unprecedented opportunity to put the global economy within everyone's reach while doing the most important work of your career. About the team As Stripe's user base and global footprint grows dramatically, we face uniquely complex operational challenges at the intersection of payments infrastructure, financial data integrity, and global scale. The Stripe Delivery Center (SDC) provides operational leverage across Stripe's portfolio supporting external users and internal teams with precision and speed. What you’ll do As a Technical Operations Analyst on the Payments team, you will own the reliability and accuracy of some of the world's most critical payment flows, a platform processing hundreds of billions of dollars annually. You will sit at the intersection of engineering, finance, and operations: triaging live payment failures, driving reconciliation accuracy, and partnering with financial institutions globally to resolve issues fast. This is not a passive monitoring role. You will be expected to independently own investigations end-to-end, identify systemic issues before they escalate, and drive process improvements that scale with Stripe's growth. Responsibilities Own reconciliation and payments-related investigations, ensuring accurate ledgering of funds and resolving discrepancies with banking partners swiftly and precisely. Proactively monitor payment performance across users and payment methods; triage degradation alerts, diagnose root causes, and communicate findings clearly to technical and non-technical stakeholders. Serve as the escalation point for complex support inqui

About the Team At Trendyol Legal, we go beyond compliance—shaping business decisions with legal insight and strategic perspective. As trusted advisors, we support teams across the company on matters ranging from contracts and corporate law to labor, competition, transportation, and regulatory frameworks. By embedding legal thinking into every stage of business design, we safeguard the company’s integrity while enabling agile, sustainable growth. We are seeking a Senior Legal Counsel to join our European Legal team. This individual will be covering a broad and complex portfolio of regulatory and commercial topics, including marketplace seller matters, product compliance, customs law, payment regulation, and warehouse and logistics agreements. The role requires someone who combines deep legal expertise with strong business acumen, the ability to lead and develop a team, and the drive to build scalable legal frameworks in a fast-paced, cross-border environment.

Our Purpose Mastercard powers economies and empowers people in 200&#43; countries and territories worldwide. Together with our customers, we’re helping build a sustainable economy where everyone can prosper. We support a wide range of digital payments choices, making transactions secure, simple, smart and accessible. Our technology and innovation, partnerships and networks combine to deliver a unique set of products and services that help people, businesses and governments realize their greatest potential. Title and Summary Senior Analyst, Customer Performance, Brand-1 Overview Mastercard operates the world’s fastest payment processing network, connecting consumers, financial institutions, merchants, governments, and businesses in more than 210 countries and territories. Every day, everywhere, we use our technology and expertise to make payments safe, simple and smart. We know safety and security are the top priorities of our customers, cardholders and partners, so we won’t stand still in developing new and better ways to keep payments safe. • Do you have experience conducting investigations, reviewing evidence, and documenting case outcomes? • Do you have knowledge of merchant onboarding, monitoring, customer response review, and potential Mastercard Standards violations? • Are you a high performer with strong analytical, documentation, and project management skills? • Are you collaborative, detail-oriented, and able to support credible investigations in a fast-paced environment? Mastercard’s Franchise Brand Performance Team advances ecosystem health and profitability by engaging our customers to optimize performance and to enhance the strength of our brand, acceptance network, and data. Role • Preserve the integrity of the Mastercard brand by conducting investigative case work under the Business Risk Assess