Senior Advisor

As a Senior Advisor, you will provide strategic and analytical support to the Payment Integrity team, evaluating pre- and post-payment programs, clinical coding audits, and recovery initiatives to identify opportunities for savings and improved performance.

You will turn data and program results into actionable insights and business cases while partnering across Finance, Operations, Clinical, Network, Claims, Product, and vendor teams to advance enterprise affordability goals.

Responsibilities:

• Support strategic medical cost analytics by identifying trends, risks, and affordability opportunities across cost containment and payment integrity programs.
• Tell the story behind the data, translating complex findings into clear, executive-ready insights for technical, operational, and senior leadership audiences to inform the strategic roadmap.
• Own financial impact assessments and business cases for initiatives, including forecasts, variance analysis, and recommendations to improve performance.
• Support program measurement and performance monitoring for pre-payment and post-payment editing, coding audits, and recovery programs across dashboards, scorecards, and executive materials.
• Identify and size new opportunities by assessing billing patterns, coding and reimbursement dynamics, and drivers of wasteful or abusive practices.
• Partner across the enterprise (e.g., Contracting, Coverage Policy, Commercial Payment Integrity, Compliance, Network Analytics, Claims, Reserving, Product) to align insights to decisions and execution.
• Support vendor evaluation and sourcing through data-driven analysis that informs negotiations, pricing structures, and performance guarantees.
• Advance reporting and analytics by improving data quality, strengthening controls, and enabling scalable/self-service solutions through automation and thoughtful use of AI-enabled tools.

Requirements:

• Bachelor's degree in a quantitative field (e.g., Economics, Finance, Data Science, Data Analytics, Actuarial Science, Business, Public Health, Applied Mathematics) or equivalent experience.
• 8+ years of progressive experience in medical cost analytics, payment integrity, financial modeling, or related fields.
• Strong analytical and technical skills, with hands-on experience using tools such as SQL, Excel, SAS, Tableau, Databricks (or similar platforms).
• Knowledge of reimbursement methodologies and coding (e.g., MS-DRG, APCs, HCPCs, RBRVS) and familiarity with professional and facility claim constructs.
• Experience modernizing analytics through automation and thoughtful use of AI-enabled and advanced analytics methods (e.g., predictive modeling, NLP, machine learning) where they add measurable value.

Benefits:

• Comprehensive range of benefits, including medical, vision, dental, and well-being and behavioral health programs.
• 401(k), company-paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year, paid holidays, and leaves of absence.