Role Description

The Senior Lead of Carrier Engagement is responsible for the end‑to‑end performance, satisfaction, and operational excellence of the company’s carrier network. This role develops, manages, and strengthens strategic carrier relationships while ensuring accuracy, compliance, service quality, and a consistently positive carrier experience. Acting as the primary liaison between carriers and internal teams, the Senior Lead drives alignment, transparency, and continuous improvement across communication, operations, payment processes, and partnership programs.

This position oversees key functions including:

• Payment operations
• Quality assurance
• Carrier engagement
• Experience management

The Senior Lead initiates and maintains savings and performance improvement initiatives with carrier partners, identifying opportunities for operational enhancements and friction reduction. The role also provides analytical insights and performance reporting during internal and external business reviews, representing the organization in client and carrier facing discussions.

Additionally, the Senior Lead collaborates closely with IT and cross-functional teams to enhance tools, processes, and technology impacting carriers and the carrier engagement team. By championing operational integrity, strengthening partnerships, and driving data-informed improvements, this role ensures a seamless, reliable, and transparent end‑to‑end experience for carriers, partners, and internal stakeholders while supporting organizational growth.

Qualifications

• Bachelor’s degree in business, operations, or related field; advanced degree preferred
• Payor/Carrier experience is required
• 5 - 10+ years of experience in payment integrity operations, financial operations, or quality management
• Experience managing the payment integrity operations process, workflow patterns and complex operational programs
• Experience managing external partners or vendors preferred
• Strong analytical, problem‑solving, and process‑improvement skills

Requirements

• Strong relationship‑building and communication skills
• Ability to navigate, understand and explain claims and billing data
• Some combination of coding/medical records or carrier payment integrity work
• Analytical mindset with the ability to interpret large data sets and drive decisions
• Excellent organizational and project management abilities
• Ability to navigate complex issues with diplomacy and accountability

Success Indicators

• Carriers consistently meet or exceed performance expectations
• Strong, collaborative relationships with carriers and internal teams
• Reduced escalations and improved issue‑resolution timelines
• Clear, consistent communication and documentation across all carrier interactions
• Measurable improvements in carrier satisfaction and operational efficiency

Company Description

SmartLight Analytics was formed by a group of industry insiders who wanted to make a meaningful impact on the rising cost of healthcare. With this end in mind, SmartLight works for self-funded employers to reduce wasteful spending in their healthcare plan through our proprietary data analysis. Our process works behind the scenes to save money without interrupting employee benefits or requiring employee behavior changes.