Manager, Payment Integrity Program Development & Innovation

Sagility combines industry-leading technology and transformation-driven BPM services with decades of healthcare domain expertise to help clients draw closer to their members. The company optimizes the entire member/patient experience through service offerings for clinical, case management, member engagement, provider solutions, payment integrity, claims cost containment, and analytics. Sagility has more than 25,000 employees across 5 countries.

Manager, Payment Integrity Program Development & Innovation is responsible for leading a team of healthcare payment integrity experts focused on developing, implementing, and optimizing complex audit programs that identify and recover healthcare overpayments. This role oversees the creation of audit concepts, claim selection methodologies, and recovery strategies across inpatient, outpatient, professional, specialty, and durable medical equipment (DME) claim types.
The Manager serves as a key leader within the Payment Integrity organization, partnering with clinical, operational, analytics, appeals, and client-facing teams to drive innovative audit solutions, maximize recovery opportunities, and ensure program effectiveness. This position plays a critical role in expanding audit capabilities, improving financial outcomes, and delivering exceptional value to clients. Job title:

Manager, Payment Integrity Program Development & Innovation Job Description:

Manager, Payment Integrity Program Development & Innovation is responsible for leading a team of healthcare payment integrity experts focused on developing, implementing, and optimizing complex audit programs that identify and recover healthcare overpayments. This role oversees the creation of audit concepts, claim selection methodologies, and recovery strategies across inpatient, outpatient, professional, specialty, and durable medical equipment (DME) claim types.
The Manager serves as a key leader within the Payment Integrity organization, partnering with clinical, operational, analytics, appeals, and client-facing teams to drive innovative audit solutions, maximize recovery opportunities, and ensure program effectiveness. This position plays a critical role in expanding audit capabilities, improving financial outcomes, and delivering exceptional value to clients.
Essential Responsibilities
Leadership & Team Development

- Lead, mentor, and develop a team of Subject Matter Experts responsible for complex audit program design and implementation.

- Foster a culture of accountability, collaboration, innovation, and continuous improvement.

- Establish performance expectations and monitor team productivity, quality, and operational effectiveness.

- Support recruitment, onboarding, professional development, and succession planning initiatives.

Audit Program Development

- Develop and maintain a portfolio of complex payment integrity audit concepts and recovery initiatives.

- Identify emerging overpayment risks and reimbursement vulnerabilities across multiple healthcare claim types.

- Evaluate opportunities based on financial impact, operational feasibility, recovery potential, and client value.

- Collaborate with internal stakeholders to prioritize and implement new audit programs.

Claim Selection Strategy

- Partner with analytics and technology teams to design, validate, and optimize claim selection methodologies and audit algorithms.

- Define business requirements and selection criteria for complex audit programs.

- Monitor audit performance and continuously refine targeting strategies to improve recovery yield and audit accuracy.

- Evaluate program metrics, including hit rates, recovery rates, overturn rates, and return on investment.

Regulatory & Technical Expertise

- Provide subject matter expertise on healthcare reimbursement methodologies, payment policies, coding guidelines, and industry best practices.

- Ensure audit concepts and methodologies comply with applicable regulatory, contractual, and operational req