Director, Payment Integrity Strategy
About Us
Abacus Insights is transforming how data works for health plans. Our mission is simple: make healthcare data usable, so the people responsible for care and cost decisions can act faster, with confidence.
We help health plans break down data silos to create a single, trusted data foundation. That foundation powers better decisions —so plans can improve outcomes, reduce waste, and deliver better experiences for members and providers alike.
Backed by $100M from top investors, we’re tackling big challenges in an industry that’s ready for change. Our platform enables GenAI use cases by delivering clean, connected, and reliable healthcare data that can support automation, prioritization, and decision workflows—and it’s why we are leading the way.
Our innovation begins with people. We are bold, curious, and collaborative—because the best ideas come from working together. Ready to make an impact? Join us and let's build the future together.
About the Role
Abacus Insights is seeking a Director of Payment Integrity Strategy to serve as a senior leader driving the evolution of our internal payment integrity capabilities. This role brings deep payer domain expertise and a strategic mindset to help shape how payment integrity insights, analytics, and methodologies are embedded into Abacus offerings and internal practices.
This is a high‑impact, senior individual contributor role with broad influence across Product, Engineering, Analytics, and Client Delivery. You will translate complex payment integrity concepts into clear strategies, frameworks, and insights that strengthen Abacus’ ability to deliver value to health plan clients.
Your day to day
- Act as a strategic leader for payment integrity across Abacus, shaping internal approaches to pre‑pay, post‑pay, recovery, and FWA‑related use cases.
- Partner closely with Product, Engineering, Analytics, and Delivery teams to guide the design and evolution of payment integrity‑related capabilities, workflows, and analytical approaches.
- Translate complex payment integrity findings, data patterns, and industry practices into clear insights, narratives, and recommendations for internal stakeholders and leadership.
- Review and guide analytical methodologies to ensure accuracy, relevance, and alignment with payer operational realities.
- Contribute to internal frameworks, playbooks, and documentation that enable consistent, scalable payment integrity practices across teams.
- Serve as a thought partner to senior leaders on industry trends, regulatory considerations, and emerging payment integrity strategies.
- Support internal enablement by sharing expertise, best practices, and lessons learned to raise organizational fluency in payment integrity.
What you bring to the team
- Bachelor’s degree in a related field (e.g., healthcare administration, business, analytics, or similar) or equivalent work experience.
- 10+ years of experience in healthcare payer environments with deep expertise in payment integrity, claims analytics, overpayment identification, recovery, and FWA concepts.
- Prior experience in healthcare technology, analytics platforms, or data‑enabled services.
- Deep hands-on experience in pre-pay, claim audit/complex claim review, and medical coding/auditing.
- Strong understanding of CMS and state-level regulatory policies and guidelines.
- Strong understanding of payer operations and how payment integrity strategies translate into measurable financial and operational outcomes.
- Able to apply business logic and subject matter expertise to translate payment integrity data sources into pre-pay and post-pay payment integrity solutions.
- Experience partnering with Product, Engineering, Analytics, Sales, and Operations teams in a data‑driven technology or SaaS environment.
- Strong communication and presentation skills.
- Strategic mindset, intellectual curiosity, and comfort operating in a fast‑paced, growth‑oriented organization.
What we would love to see, but not required
Experience with post‑pay (recovery), appeals and special investigations, and FWA‑related use cases.
What you’ll get in return
- Unlimited paid time off – recharge when you need it
- Work from anywhere – flexibility to fit your life
- Comprehensive health coverage – multiple plan options to choose from
- Equity for every employee – share in our success
- Growth-focused environment – your development matters here
- Home office setup allowance – one-time support to get you started
- Monthly cell phone allowance – stay connected with ease #LISB1 #LI-Remote
Our Commitment as an Equal Opportunity Employer
As a mission-led technology company helping to drive better healthcare outcomes, Abacus Insights believes that the best innovation and value we can bring to our customers comes from diverse ideas, thoughts, experiences, and perspectives. Therefore, we dedicate resources to building diverse teams and providing equal employment opportunities to all applicants. Abacus prohibits discrimination and harassment regarding race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.
At the heart of who we are is a commitment to continuously and intentionally building an inclusive culture—one that empowers every team member across the globe to do their best work and bring their authentic selves. We carry that same commitment into our hiring process, aiming to create an interview experience where you feel comfortable and confident showcasing your strengths. If there’s anything we can do to support that—big or small—please let us know.