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.
Department: Payment Integrity
We are seeking a Senior Manager with strong US Healthcare domain knowledge and proven training experience. This role involves consulting on healthcare processes, driving compliance, and delivering impactful training programs to internal teams and clients with focus on Provider contracts & pricing
Job Summary:
The Senior Manager will serve as a Domain expert in contract loading, concept validation & flagging discrepancies to ensure payment accuracy and integrity, while also leading training initiatives for internal teams and clients.
This role involves providing strategic consulting, designing and delivering training programs, and ensuring operational excellence across teams. The manager will collaborate with stakeholders to implement best practices, optimize workflows, and drive transformation initiatives. This role demands strong analytical skills, attention to detail, and a deep understanding of claims processing and contract management systems.
Key Area of Responsibilities:
A. Contract loading & Consulting
- Provide expertise in US healthcare regulations, payer-provider processes, HIPAA compliance, and revenue cycle management.
- Review and update contract details including fee schedules, reimbursement rates, and payment terms to support accurate claims adjudication.
- Ensure timely and accurate updates to contract data, reflecting the most current agreement terms and minimizing payment discrepancies.
- Support implementation of