Healthcare Program Integrity Solutions Consultant

Description

At Commence, we’re the start of a new age of data-centric transformation, elevating health outcomes and powering better, more efficient process to program and patient health. We combine quality data-driven solutions that fuel answers, technology that advances performance, and clinical expertise that builds trust to create a more efficient path to quality care.

With human-centered, healthcare-relevant, and value-based solutions, we create new possibilities with data. We provide proof beyond the concept and performance beyond the scope with a focus on efficiencies that transform the lives of those we serve. With a culture driven by purpose, straightforward communication and clinical domain expertise, Commence cuts straight to better care.

The Healthcare Program Integrity Solutions Consultant will play a significant role in the growth and success of Commence in the commercial payer market. The ideal candidate serves as a trusted authority on healthcare fraud, waste and abuse, payment integrity operations, and Special Investigative Unit (SIU) functions, and brings that expertise directly to bear in support of sales, customer success, product, and engineering teams.

This is a domain-first, solutions-oriented role. The right candidate understands how payment integrity departments and SIU teams operate day to day inside commercial health plans. Additionally, this candidate has the ability to bridge that operational knowledge with technology, helping prospective customers see how the Commence platform maps to their real-world FWA and payment integrity workflows. This person serves as the trusted domain voice throughout the commercial sales cycle and beyond.

This role also provides domain support during customer onboarding and implementation to ensure the platform aligns with each client's payment integrity workflows.

• Serve as the primary internal and external expert on commercial health plan payment integrity operations, including pre-payment review, post-payment recovery, SIU investigations, and provider fraud and billing scheme identification
• Develop and maintain payment integrity-focused documentation, use cases, and enablement materials for Sales, Pre-Sales, and Customer Success teams
• Partner with product management and engineering to ensure commercial payer payment integrity workflows and SIU operational realities are reflected in product design and roadmap decisions
• Stay current on commercial payer fraud trends, payment integrity best practices, HIPAA compliance requirements, and regulatory changes that impact health plan program integrity operations
• Identify new product opportunities based on emerging payment integrity trends, payer operational shifts, and evolving commercial health plan needs
• Represent Commence's payment integrity expertise at industry forums, payer-facing events, and conferences to strengthen credibility and visibility in the commercial health plan market

• Partner with sales teams to provide payment integrity and FWA domain expertise throughout the commercial sales cycle from initial discovery through close
• Help the sales team qualify and prioritize opportunities by identifying where Commence's platform creates the clearest operational fit and business value for commercial payer payment integrity departments
• Conduct structured discovery conversations to understand a prospect's current payment integrity operations, SIU structure, pre- and post-payment review processes, and investigation challenges
• Lead or participate in product demonstrations, serving as the domain voice that connects Commence's platform capabilities to the specific payment integrity workflows and SIU operations of each…