Complex Clinical Audit Business Solutions Lead

Abacus Insights is seeking a Complex Clinical Audit Business Solutions Lead to translate payment integrity audit knowledge into product capabilities for health plans. This role involves partnering with cross-functional teams to define audit logic, identify savings, and improve product accuracy. The ideal candidate will have extensive experience in healthcare payment integrity and a strong understanding of audit programs and product requirements.

• Serve as subject matter expert for payment integrity methodologies and audit programs
• Translate payer pain points and audit policy into product capabilities
• Define audit concepts, savings opportunities, and defensibility standards
• Partner with engineering to develop AI solutions for payment integrity
• Support roadmap prioritization, pilot launches, and outcome reviews
• Translate audit operations and payer requirements into software workflows