Director, Payment Integrity - REMOTE EST OR CST

JOB DESCRIPTION

Job Summary

Responsible for leading the strategic development, governance, implementation, maintenance, and optimization of the organization's post-pay payment integrity concept portfolio. This role leads a team of Business Analysts responsible for maintaining concept white papers, business requirements, operational specifications, and enhancement requests supporting Molina’s portfolio of post pay concepts.

The Director serves as a key liaison between Health Plans, Data Science, and Executive Leadership teams to ensure payment integrity concepts are effectively developed, implemented, maintained, and optimized to achieve financial and operational objectives. This position oversees a high-volume, fast-paced environment supporting concept lifecycle management, stakeholder engagement, and continuous improvement initiatives.

Essential Job Duties

• Develop and execute the strategic roadmap for the post-pay payment integrity concept portfolio, ensuring alignment with organizational financial, operational, and regulatory objectives.
• Oversee the end-to-end lifecycle of payment integrity concepts, including intake, prioritization, requirements development, implementation, testing, deployment, maintenance, enhancement, and retirement.
• Champion and drive continuous improvement initiatives that enhance scalability, automation, productivity, and concept performance.
• Lead, mentor, and develop a team of Business Analysts responsible for concept white papers, business requirements, enhancement requests, and concept maintenance activities.
• Establish performance expectations, development plans, and succession strategies that support organizational growth and talent development.
• Ensure the accuracy, consistency, and governance of concept white papers, business requirements, operational specifications, and supporting documentation.
• Provide oversight of concept change management, maintenance activities, and enhancem