Healthcare Claims Pricing & Payment Integrity Specialist

Job description

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. Job title: Healthcare Claims Pricing & Payment Integrity Specialist Job Description: Position Overview: Sagility Payment Integrity Solutions specializes in identifying provider overpayments for health plans. Our internal claims repricing platform recalculates reimbursement using CMS and state guidance, rates and fee schedules, and plan/provider contract terms. We are seeking a technical healthcare claims pricing & payment integrity specialist to support and enhance this work. This is a domain-driven, hands-on role focused on understanding and researching reimbursement methodologies, translating them into pricing logic, and validating outcomes using data and SQL queries. The role partners closely with the SQL engineering/development team to e...