Director, Payment Integrity (Pre-Pay Edits) - REMOTE
Molina Healthcare · Centralia, WA
Job description(tap to read)
Job Summary Leads and directs team responsible for payment integrity activities including recovery operations. Responsible for performance, quality levels and establishing procedures and techniques that achieve optimal payment integrity operational standards and production targets. Essential Job Duties • Develops and executes the strategic roadmap for payment integrity functions, ensuring alignment with enterprise objectives and regulatory standards. • Oversees multiple program areas (e.g., COB, subrogation, data mining, pre-pay edits, PI disputes) and ensures consistent governance, methodology, and performance management across markets. • Leads enterprise projects and large-scale initiatives that drive financial improvement, cost containment, and operational transformation. • Partners with executive leadership and shared services functions to integrate payment integrity objectives into corporate planning, rate setting, and compliance frameworks. • Establishes departmental goals, KPIs, and performance reporting mechanisms that measure and communicate enterprise payment integrity outcomes. • Provides subject matter expertise across claims processing, configuration logic, audit readiness, and vendor governance to ensure accuracy and scalability. • Represents Payment Integrity at enterprise governance meetings, shared services councils, and external regulatory discussions. • Oversees vendor selection, contracting, and ROI management to maximize recovery efficiency and ensure long-term value creation. • Champions innovation through automation, advanced analytics, and data-driven decision-making. • Mentors leaders and develops succession pipelines, building organizational capability and leadership readiness. Required Qualifications • At least 8 years of experience supporting health care operations, including 5 years payment integrity/claims experience, or equivalent combination of relevant education and experience. • At least 3 years management/leadership experience. • Managed care payor experience, preferably in Medicare/Medicaid government-sponsored programs. • Ability to establish and maintain positive and effective work relationships with coworkers, members, providers and customers. • Strong organizational and time-management skills; ability to manage simultaneous projects and tasks to meet internal deadlines. • Excellent verbal and written communication skills. • Microsoft Office suite and applicable software program(s) proficiency. Preferred Qualifications • Understanding of ICD-9/10CM, MS-, AP- and APR-DRG reimbursement. • Electronic medical record (EMR) and medical record repository experience. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V #J-18808-Ljbffr
Customer Service Enrollment Specialist - Remote
American Income Life - Giddens Organization · Abilene, TX
Benefits Representative 100% Virtual • 65,000-80,000 • 40 Hours per Week • Actively hiring Crafting Brighter Futures for Families At the forefront of specialized financial services, we help families safeguard their assets and promises a profound purpose: ensuring a brighter future for every client. Role Overview: As a Benefits Representative, you play a pivotal role in helping families protect their assets and secure their futures. You'll be the face of Globe Life, embodying our values and commitment. Primary Responsibilities: • Engage with clients to understand their financial goals and concerns. • Present tailored solutions to safeguard their assets effectively. • Maintain a pulse on the industry, ensuring you offer the best and most updated advice. • Foster relationships and ensure our clients always have someone they can turn to. Why Us? • Remote Work: Enjoy the flexibility of a full-time remote role. • Unlimited Earning Potential: Your dedication determines your earnings. • Company Culture: We're relaxed, high-energy, and treat every member like family. • Grow with Us: Dive into continuous learning and development opportunities. Application Process: 1. Submit Your Application: A hiring manager will review your application & resume and get back to you within 24 hours. 2. Schedule Company Overview: Select applicants will be contacted to schedule a position overview, detailing everything you need to know about the job details and your responsibilities. This 20-30 minute session is typically* done virtually for your convenience. 3. Interact with Us: During the overview, you'll have the chance to chat with our team members and ask any questions. Following the overview you'll be prompted to complete a brief assessment to gauge your understanding and compatibility with the position.
Insurance Sales Representative - Work From Home
American Income Life - Giddens Organization · Abilene, TX
Benefits Representative 100% Virtual • 65,000-80,000 • 40 Hours per Week • Actively hiring Crafting Brighter Futures for Families At the forefront of specialized financial services, we help families safeguard their assets and promises a profound purpose: ensuring a brighter future for every client. Role Overview: As a Benefits Representative, you play a pivotal role in helping families protect their assets and secure their futures. You'll be the face of Globe Life, embodying our values and commitment. Primary Responsibilities: • Engage with clients to understand their financial goals and concerns. • Present tailored solutions to safeguard their assets effectively. • Maintain a pulse on the industry, ensuring you offer the best and most updated advice. • Foster relationships and ensure our clients always have someone they can turn to. Why Us? • Remote Work: Enjoy the flexibility of a full-time remote role. • Unlimited Earning Potential: Your dedication determines your earnings. • Company Culture: We're relaxed, high-energy, and treat every member like family. • Grow with Us: Dive into continuous learning and development opportunities. Application Process: 1. Submit Your Application: A hiring manager will review your application & resume and get back to you within 24 hours. 2. Schedule Company Overview: Select applicants will be contacted to schedule a position overview, detailing everything you need to know about the job details and your responsibilities. This 20-30 minute session is typically* done virtually for your convenience. 3. Interact with Us: During the overview, you'll have the chance to chat with our team members and ask any questions. Following the overview you'll be prompted to complete a brief assessment to gauge your understanding and compatibility with the position.
Call Center Rep Work From Home
American Income Life - Giddens Organization · Abilene, TX
Benefits Representative 100% Virtual • 65,000-80,000 • 40 Hours per Week • Actively hiring Crafting Brighter Futures for Families At the forefront of specialized financial services, we help families safeguard their assets and promises a profound purpose: ensuring a brighter future for every client. Role Overview: As a Benefits Representative, you play a pivotal role in helping families protect their assets and secure their futures. You'll be the face of Globe Life, embodying our values and commitment. Primary Responsibilities: • Engage with clients to understand their financial goals and concerns. • Present tailored solutions to safeguard their assets effectively. • Maintain a pulse on the industry, ensuring you offer the best and most updated advice. • Foster relationships and ensure our clients always have someone they can turn to. Why Us? • Remote Work: Enjoy the flexibility of a full-time remote role. • Unlimited Earning Potential: Your dedication determines your earnings. • Company Culture: We're relaxed, high-energy, and treat every member like family. • Grow with Us: Dive into continuous learning and development opportunities. Application Process: 1. Submit Your Application: A hiring manager will review your application & resume and get back to you within 24 hours. 2. Schedule Company Overview: Select applicants will be contacted to schedule a position overview, detailing everything you need to know about the job details and your responsibilities. This 20-30 minute session is typically* done virtually for your convenience. 3. Interact with Us: During the overview, you'll have the chance to chat with our team members and ask any questions. Following the overview you'll be prompted to complete a brief assessment to gauge your understanding and compatibility with the position.
Remote Customer Service/Advisor
American Income Life - Giddens Organization · Slaton, TX
Benefits Representative 100% Virtual • 65,000-80,000 • 40 Hours per Week • Actively hiring Crafting Brighter Futures for Families At the forefront of specialized financial services, we help families safeguard their assets and promises a profound purpose: ensuring a brighter future for every client. Role Overview: As a Benefits Representative, you play a pivotal role in helping families protect their assets and secure their futures. You'll be the face of Globe Life, embodying our values and commitment. Primary Responsibilities: • Engage with clients to understand their financial goals and concerns. • Present tailored solutions to safeguard their assets effectively. • Maintain a pulse on the industry, ensuring you offer the best and most updated advice. • Foster relationships and ensure our clients always have someone they can turn to. Why Us? • Remote Work: Enjoy the flexibility of a full-time remote role. • Unlimited Earning Potential: Your dedication determines your earnings. • Company Culture: We're relaxed, high-energy, and treat every member like family. • Grow with Us: Dive into continuous learning and development opportunities. Application Process: 1. Submit Your Application: A hiring manager will review your application & resume and get back to you within 24 hours. 2. Schedule Company Overview: Select applicants will be contacted to schedule a position overview, detailing everything you need to know about the job details and your responsibilities. This 20-30 minute session is typically* done virtually for your convenience. 3. Interact with Us: During the overview, you'll have the chance to chat with our team members and ask any questions. Following the overview you'll be prompted to complete a brief assessment to gauge your understanding and compatibility with the position.