Payment Integrity Letter Implementation Professional in United States

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

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. <

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

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

NMI is looking for a driven, high-performing enterprise sales professional to join our fast-growing fintech. This is a senior individual contributor, high impact role for a self-starter — someone who thrives on building pipelines, leading executive-level conversations, and consistently exceeding quota. You'll play a key role in NMI's growth — selling our API-first money movement and open banking solutions directly to enterprise and mid-market clients, all from wherever you work best. About NMI NMI, a global leader in payment technologies, allows software and sales professionals to deliver payment innovations to their clients without having to build payment expertise in house. NMI enables our partners with choice, and challenges the one-size-fits-all approach to payments. You've probably used NMI in the last 24 hours without even realizing it. We're the platform that powers success for innovative tech created by SMBs, entrepreneurs and fintech startups. We're creative problem solvers who help visionaries smash through boundaries and think beyond what's possible so they can think about what's next. But we're not just built for the tech savvy. We democratize the latest payments technology so that everyone can realize the benefits of easy payments across the full spectrum of commerce. Our mission is to use our expertise to enable more payments, in more ways and more places. We provide ISOs, Fintech Innovators and Technologists the freedom to focus on what they do best, liberating them from restricted payment solutions and giving them access to the latest payment technology now and in the future. How We Work - Our Core Values Be a Good Person, It's Simple. We treat everyone fairly and with respect. We lead with kindness, humility and integrity. We take the time to understand each other and our customers. And we serve with care, because customers are never a transaction, and always our focus Align, Trust & Go. We debate openly, listen carefully and challenge thoughtfu

The Data Analyst, Revenue Operations is responsible for turning data from multiple source systems into the reporting, models, and visualizations that power revenue, sales, and operations decision-making. Reporting into the Revenue Operations organization, this role combines hands-on SQL and data modeling with predictive segmentation, opportunity analysis, and dashboard development — and serves as a trusted reporting partner to teams across the business. You will work primarily within Revenue Operations while collaborating cross-functionally with Sales, Business and Technical Operations, Sales Enablement, Support, and Finance to get things done. About NMI NMI, a global leader in payment technologies, allows software and sales professionals to deliver payment innovations to their clients without having to build payment expertise in house. NMI enables our partners with choice, and challenges the one-size-fits-all approach to payments. You've probably used NMI in the last 24 hours without even realizing it. We're the platform that powers success for innovative tech created by SMBs, entrepreneurs and fintech startups. We're creative problem solvers who help visionaries smash through boundaries and think beyond what's possible so they can think about what's next. But we're not just built for the tech savvy. We democratize the latest payments technology so that everyone can realize the benefits of easy payments across the full spectrum of commerce. Our mission is to use our expertise to enable more payments, in more ways and more places. We provide ISOs, Fintech Innovators and Technologists the freedom to focus on what they do best, liberating them from restricted payment solutions and giving them access to the latest payment technology now and in the future. How We Work - Our Core Values * Be a Good Person, It's Simple. We treat everyone fairly and with respect. We lead with kindness, humility and integrity. We take the time to understand each other and our customers. And

About the Team OpenAI Finance ensures the organization is positioned for long-term success as we pursue our mission. The Revenue team plays a critical role in enabling OpenAI to scale its commercial offerings—overseeing billing operations, deal desk, revenue systems, and revenue accounting. We work cross-functionally with Technical Revenue, Finance Data, and Revenue Systems teams to support complex commercial arrangements, improve operational efficiency, and maintain financial integrity. About the Role As a Revenue Accounting Manager, you will own revenue accounting processes for consumption and usage-based revenue recognition while helping implement and maintain the systems, data flows, and accounting rules that support accurate financial reporting. You will serve as a key execution partner on onboarding new revenue streams, Fusion Accounting Hub rule updates, translating accounting requirements into expected journal entries, source-to-general-ledger mappings, user acceptance testing, data validation, and controlled operating processes. We’re looking for a hands-on revenue accounting owner who combines strong close discipline with systems and data fluency, independently coordinates cross-functional implementation work, and strengthens the accounting infrastructure supporting OpenAI’s growth. This role is based in San Francisco, CA. We use a hybrid work model of 3 days in the office per week and offer relocation assistance to new employees. In this role, you will: Own the monthly close for usage-based revenue and payment processor accounting, including journal entries, reconciliations, variance analysis, controls, and supporting documentation. Prepare and review revenue-related journal entries while understanding the underlying transaction lifecycle, accounting methodology, billing arrangements, source data, and expected financial reporting outcomes. Perform reconciliations for key revenue accounts, investigate discrepancies, and drive issues to resolution. Own flux

Become a part of our caring community The Regional Senior TRICARE Community Liaison (TCL) is an important Humana Military representative committed to operational excellence, consistency, and accountability in the administration of TRICARE services within a defined territory in the East Region. You will provide expert guidance to nationally contracted healthcare providers and support facilities who have footprints across both East and West Regions. The primary focus of the Regional Senior TCL is to develop and sustain strong, collaborative relationships with all National Health System providers in the East Region. You will be cover all National contracted providers and large health systems regardless of location or type of care provided. Through clear and concise written and verbal communication, the Regional Senior TCL ensures provider understanding of the TRICARE health plan, TRICARE Policy and Regulations and how to navigate the Military Health System. The Regional Senior TCL is self-directed and uses independent, critical decision-making in managing time, setting priorities, addressing general inquiries, and resolving both straightforward inquiries, complicated problems and concerns raised by providers. This position upholds rigorous operational standards and ensuring consistent, high-quality delivery of TRICARE services. You will support customer service, conduct outreach, maintain network adequacy and access to care. You will manage provider relations and education, and ensure effective provider management within the assigned area. You will lead the review of TRICARE inquiries, complaints, and concerns from beneficiaries, providers, and government personnel, ensuring a resolution through professionalism and integrity. Additional responsibilities involve supporting the implementation of Alternative Payment Methodologies and Demonstration Pilots that adv

About the Team Consumer Monetization builds the experiences and systems that power how customers purchase and pay for OpenAI products. Our scope spans purchasing flows, payments, subscriptions, and billing, along with the shared capabilities that support new products, offers, and distribution channels. We own both customer-facing experiences and the underlying platforms that power them. We partner closely with Product, Design, Growth, Data Science, and engineering teams across OpenAI to make purchasing effective and reliable, and new offerings easier to launch and monetize. About the Role We’re looking for experienced Staff+ engineers to evolve the payments, billing, and subscription capabilities that support OpenAI’s growing product portfolio. You’ll tackle problems where correctness, reliability, and flexibility are essential: supporting new billing requirements, managing the billing lifecycle, synchronizing state across internal systems and external providers, and enabling new products and commercial models. Your work may span several areas based on your expertise and team priorities: Billing and monetization capabilities: Extend billing capabilities and improve integrations and state consistency across systems to support new products and business models. Subscriptions: Orchestrate purchases, renewals, plan changes, cancellations, and recovery, ensuring customers are charged correctly and receive the right benefits. Payments: Expand payment capabilities through processor integrations, routing, and broader payment-method coverage. Risk and integrity: Partner with risk and integrity teams to integrate controls into purchasing flows, reducing abuse while protecting legitimate customer experiences. You’ll help set technical direction while remaining hands-on in implementation and delivery. This is an opportunity to solve complex engineering problems at scale, connect architecture decisions to customer and business outcomes, and help other engineers take on broader ow

Airbnb was born in 2007 when two hosts welcomed three guests to their San Francisco home, and has since grown to over 5 million hosts who have welcomed over 2 billion guest arrivals in almost every country across the globe. Every day, hosts offer unique stays and experiences that make it possible for guests to connect with communities in a more authentic way. The Community You Will Join: Airbnb’s mission is to create a world where anyone can belong anywhere. Airbnb Payments team supports this mission by economically empowering Airbnb businesses and our global community of guests and hosts. Airbnb Payments team allows any two people in the world to frictionlessly exchange money with easy to use payments services. It is a core strategy to fulfill Airbnb’s belongs anywhere mission. We are building a world-class payments platform that moves billions of dollars, in 191 countries, with 75 currencies, through a complex ecosystem of payments partners. We build and maintain our own in-house global payments platform because no solution exists with the global reach needed. The Ledger team is part of the core platform of the Airbnb Payments ecosystem, where we own the financial integrity of Airbnb's money movement. The team is building Airbnb's financial system of record and the platform that governs when money is held rather than moved. The team engineers are responsible for ensuring that every payment event is recorded accurately and completely, and that money moves — or is held — exactly as Airbnb's obligations and controls require, in a way that is reliable, accurate, timely, scalable, and auditable. We are evolving these platforms to enable the next generation of Airbnb payments products, and the engineers who join us will help set the foundations those products are built on. The Difference You Will Make: We are looking for talented and self-motivated Senior Software Engineers who are passionate about working in this highly dynamic domain and collaborating with world

Replit is the agentic software creation platform that enables anyone to build applications using natural language. With millions of users worldwide, Replit is democratizing software development by removing traditional barriers to application creation. About the Role We're hiring a hands-on Engineering Manager to build and lead Replit's Anti-Abuse team from the ground up. This is a foundational 0-to-1 role: you'll define the anti-abuse roadmap, hire a small team of engineers and data analysts, and ship the systems that protect Replit's platform, users, and economics from adversarial actors. You'll partner across Support, Legal, Security, Infrastructure, and the Money and Growth teams to make abuse economically unviable while keeping friction low for legitimate users. Replit sits at the frontier of AI-native abuse. Our platform is a target for phishing and scam hosting, cryptomining, LLM token farming, card and coupon fraud, and increasingly, abuse driven by AI agents themselves. The team you build will define how Replit defends against all of it. What You'll Do Build the anti-abuse roadmap from scratch : Define the threat model, prioritize across abuse vectors (phishing/scam hosting, cryptomining, token farming, payment fraud, AI agent exploitation), and translate it into a shipping plan with clear sequencing and tradeoffs. Design progressive verification and identity infrastructure : Build the "ladder of trust" that gates increasing platform capabilities (referrals, additional credits, access to powerful agent features, Missions) behind escalating verification. This includes a humanity/identity layer that's distinct from user accounts, integrations with KYC-grade verification providers, and the policy engine that decides what level of trust unlocks what behavior. This infrastructure is core not just to promo integrity but to how Replit safely expands agent capabilities over time. Ship as a hands-on EM : Stay in the code. Use the latest AI coding tools (including Rep

About Ramp Ramp is building the smart infrastructure for finance teams, embedded in the transaction flow of every dollar a business spends. We automate how over $200B in annualized spend flows in and out of 70,000+ companies: authorizing payments, flagging risk, categorizing spend, and closing books. The problems are high-stakes, data-dense, and unforgiving. We hire people with high agency and high urgency. We look for slope over intercept. We care less about where you trained and more about what you’ve built. At Ramp, everyone is a builder who owns problems end to end and makes consequential decisions that shape the outcome. The median Ramp customer saves 5% and grows revenue 16% in their first year – far in excess of businesses operating without Ramp. We believe every ambitious company deserves the same. If you want to build systems that directly shape how companies move and manage billions, Ramp is the place to do it. About the Role We’re looking for an experienced Equity Operations to oversee the company’s global equity programs and ensure operational excellence, compliance, and scalability as we continue to grow. This role will sit within the Finance organization and partner closely with Legal, People, and external vendors to manage all aspects of our equity lifecycle from issuance and reporting to governance and employee education. You’ll serve as the subject-matter expert on all things related to stock administration, with ownership of the processes that support our equity platform, financial reporting, and employee experience. What You'll Do Own daily administration of the company’s equity plans, including stock option grants, RSUs, exercises, repurchases, and cancellations. Partner with People Operations to support onboarding, offboarding, and employee communications related to equity. Maintain accuracy and integrity of data in the equity management system (Shareworks). Assist the accounting team with valuation of awards in Shareworks, as well as other comp

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 Fraud Strategy is responsible for building scaled fraud mitigation systems that prevent fraud and protect the financial ecosystem, while minimizing disruption to good users. The fraud team’s mission is to protect Stripe, our users, and the broader financial ecosystem from actors who abuse Stripe accounts for financial gain. What you’ll do As a Fraud Strategist, you will be responsible for building strategies to mitigate fraud (buyer fraud, seller fraud and account fraud) on new and existing Stripe products. You will enable safer money movement for our users and help Stripe manage fraud risks intelligently. The stakes are high, and you will be up against ever-evolving challenges. You will face some of the most complex and dynamic problems at the company, and the nature of your work will evolve rapidly to combat new and more sophisticated challenges to Stripe's integrity in the financial ecosystem. You'll partner closely with Product, Engineering, Data Science, Operations and other Risk Strategy functions to ensure fraud controls are embedded in every Stripe product. Beyond protecting against fraud risk, you'll drive innovation in how Stripe approaches fraud management— staying ahead of emerging fraud trends and pushing the boundaries of what effective, scalable fraud risk management looks like at a global payments company. Responsibilities Monitor portfolio to identify, mitigate and predict risky behavior that could result in loss