Payment Integrity Specialist

Job description

**Council Capital is a healthcare-focused private equity firm based in Nashville, Tennessee, managing over $350 million in committed capital.** We invest in lower middle market healthcare companies where we see the potential to scale purpose and performance. Our investments span control and minority positions in businesses with enterprise values between $10 million and $100 million. What sets us apart is the **Council Model**—a proven framework that surrounds founders and leadership teams with a powerful combination of support: our **CEO Council** of seasoned operators, our **Strategic Healthcare Investors** who bring real-world insight and access, and our internal **Value Creation Team**, focused on enabling growth through talent, systems, and strategy. At Council Capital, we’re not just backing companies—we’re helping build enduring businesses that improve lives and shape the future of healthcare. **ABOUT ALIVIA ANALYTICS** Alivia Analytics is a fast-growing healthcare technology company helping commercial and government payers fight fraud, waste, and abuse (FWA). Our AI-driven platform, Alivia 360, delivers payment integrity and measurable financial recoveries across the healthcare ecosystem. As a standalone SaaS company, we operate in a metrics-driven environment where sharp analysis turns directly into dollars recovered for our clients. We are scaling our audit and payment integrity team to support new and expanding payer engagements. This role sits at the center of how we generate value: finding the improper payments others miss. **THE ROLE** As a Payment Integrity Specialist, you live in the claims data. You audit payer claims across multiple lines of business, identify improper payments, and quantify the dollars you recover. This is an individual-contributor role for someone who is energized by a clear, measurable target and who takes pride in the accuracy of every finding. You will also bring new audit concepts to the table. The best people in this seat do not just work assigned audits; they spot patterns in the data and turn them into new recovery opportunities. You will be trained on each client's claims systems, so we care more about how you think about claims than which specific platform you have used. You will own your numbers. Once assigned to a client, you carry a monthly dollars-identified goal and a quality standard, and you have real autonomy in how you find and defend your findings. **WHAT YOU WILL DO** - Audit payer claims across multiple lines of business (commercial, FEP, Medicaid, Medicare) to identify improper payments and recovery opportunities. - Analyze claims data in depth to determine root causes of improper payments and build defensible audit findings. - Meet or exceed a monthly dollars-identified goal once assigned to a client (goal is set per client and audit type; expect a ramp during onboarding). - Maintain a high quality standard on all identified dollars, minimizing false positives so findings hold up under client review. - Generate new audit concepts and recovery ideas from patterns you see in the data (target of at least one new concept per month). - Support key stakeholders with on-time client deliverables, including audit results and documentation. - Apply payment integrity and claims-processing knowledge across different payers and claim systems as engagements shift. - Contribute to the team's shared knowledge (trends, methods, and audit playbooks) as our capabilities grow. **WHAT YOU BRING** - 2+ years of experience at a payer or a payment integrity / audit vendor. - Hands-on experience with claims processing and payment integrity auditing. - Exposure across multiple lines of business (commercial, FEP, Medicaid, Medicare); breadth is preferred over depth in a single line. - Strong analytical instincts: you find the significant problem in the data and work it to root cause. - Comfort with Excel and general software; you learn new claims systems quickly (system-specific training is provided per client). - A track record of hitting metric-driven, time-bound goals and staying composed under a monthly target. - High integrity and sound judgment; you make the call on findings and stand behind them. - Self-direction and ownership; you do not need to be managed through your queue. - Authorized to work in the U.S. and U.S.-based (this role handles PHI and cannot be performed offshore). **NICE TO HAVE** - Prior payment integrity auditing specifically (vs. general claims auditing). - Experience generating audit concepts / recovery ideas **Council Capital and our portfolio companies are committed to building high-performing teams by hiring the best talent—period.** We believe in putting the right people in the right seats, regardless of background, and we’re always looking for individuals who bring fresh thinking, grit, and a drive to make a difference. Thank you for considering a role with one of our companies. We’re excited to learn more about you.